Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 21, 2008; 14(19): 3028-3037
Published online May 21, 2008. doi: 10.3748/wjg.14.3028
Endoscopic ultrasound: It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review
Srinivas R Puli, Jyotsna Batapati Krishna Reddy, Matthew L Bechtold, Jamal A Ibdah, Daphne Antillon, Shailender Singh, Mojtaba Olyaee, Mainor R Antillon
Srinivas R Puli, Jyotsna Batapati Krishna Reddy, Matthew L Bechtold, Jamal A Ibdah, Daphne Antillon, Mainor R Antillon, Division of Gastroenterology and Hepatology, University of Missouri- Columbia, Columbia, Missouri 65212, United states
Shailender Singh, Mojtaba Olyaee, Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas 66160, United states
Author contributions: Puli SR designed the research; Puli SR and Batapati Krishna Reddy J collected the data; Puli SR contributed analytic tools; Puli SR analyzed data; Puli SR wrote the paper; and Puli SR, Batapati Krishna Reddy J, Bechtold ML, Ibdah JA, Antillon D, Singh S, Olyaee M, and Antillon MR helped edit the paper.
Correspondence to: Mainor R Antillon, MD, Division of Gastroenterology, One Hospital Drive, M580a, Columbia, MO 65212, United states. antillonmr@missouri.edu
Telephone: +1-573-8821013
Fax: +1-573-8844595
Received: September 3, 2007
Revised: January 3, 2008
Published online: May 21, 2008
Abstract

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy.

METHODS: Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights.

RESULTS: Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI: 82.9-86.4) to 88.0% (95% CI: 85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI: 83.2-85.9) to 96.4% (95% CI: 95.3-97.4). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10.

CONCLUSION: EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

Keywords: Endoscopic ultrasound; EUS-fine needle aspiration; Mediastinal lymphadenopathy