Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis

Abhinav Agrawal, Uzair Ghori, Udit Chaddha, Septimiu Murgu

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Background: Endobronchial ultrasound (EBUS)–guided intranodal forceps biopsy (IFB) is considered complementary to EBUS-guided transbronchial needle aspiration (TBNA) (EBUS-TBNA) for patients with intrathoracic lymphadenopathy either when additional tissue is requested for comprehensive molecular testing or for suspected lymphoma and sarcoidosis. This systematic review and meta-analysis investigated the diagnostic yield and complications of combined EBUS-IFB and EBUS-TBNA compared with EBUS-TBNA alone. Methods: A systematic search was performed of Medline, Embase, and Google Scholar for studies evaluating the use of EBUS-IFB for diagnosis of intrathoracic adenopathy, and the quality of each study was assessed using the Quality Assessment, Data abstraction and Synthesis-2 tool. Using inverse variance weighting, a meta-analysis of diagnostic yield estimations was performed. The complications related to the procedure were also reviewed. Results: Six observational studies with 443 patients undergoing 467 biopsies were included in the final analysis. Meta-analysis yielded a pooled overall diagnostic yield of 67% (312 of 467) for EBUS-TBNA and 92% (428 of 467) for EBUS-TBNA in combination with EBUS-IFB, with an inverse variance-weighted odds ratio of 5.87 (95% confidence interval, 3081 to 9.04; P <.00001) and an I2 of 15%. The overall complications included pneumomediastinum (1%), bleeding (0.8%), and respiratory failure (0.6%). The funnel plot analysis illustrated no major publication bias. Subgroup analysis showed increased diagnostic yield for lymphoma (86% vs 30%; P =.03) and sarcoidosis (93% vs 58%; P <.00001). Conclusions: The addition of EBUS-IFB to EBUS-TBNA improves the overall diagnostic yield of sampling intrathoracic adenopathy when compared with EBUS-TBNA alone. The complication rates of the combined approach are higher than with EBUS-TBNA, but they are reportedly lower than with transbronchial or surgical biopsies.

Original languageEnglish
Pages (from-to)340-348
Number of pages9
JournalAnnals of Thoracic Surgery
Issue number1
StatePublished - Jul 2022


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