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2018 Jul - Efficacy of Endosonographic Procedures in Mediastinal Restaging of Lung Cancer After Neoadjuvant Therapy

Valliappan Muthu, MD, DM, Inderpaul S. Sehgal, MD, DM, Sahajal Dhooria, MD, DM, Ashutosh N. Aggarwal, MD, DM, Ritesh Agarwal, MD, DM

Chest 2018;154(1):99-109


The optimal modality for restaging the mediastinum following neoadjuvant therapy for lung cancer remains unclear. Surgical methods are currently considered the reference standard. The present study evaluates the role of endosonographic techniques for mediastinal restaging in lung cancer.


A systematic review of PubMed and Embase databases was performed to identify studies using endoscopic ultrasound, endobronchial ultrasound, or a combination of the two for mediastinal restaging following induction therapy for stage III lung cancer. The quality of the included studies was assessed by using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. The accuracy of endosonography was analyzed by calculating the sensitivity, specificity, likelihood ratio, and diagnostic OR for each study and pooling the results by using a bivariate model. Heterogeneity and publication bias were assessed. Potential causes of heterogeneity were explored by using sensitivity analysis and meta-regression.


Ten studies (N = 574) were included. The pooled sensitivity, specificity, diagnostic OR, and positive and negative likelihood ratios were 67% (95% CI, 56-77), 99% (95% CI, 89-100), 157, 52.0, and 0.33, respectively. No complications were reported. Significant heterogeneity was observed for the outcome of sensitivity. Sensitivity analysis identified several factors accounting for heterogeneity, including study design and risk of bias. The sensitivity of the endosonographic procedure was also linked to the prevalence of N2 disease on meta-regression. Funnel plot showed publication bias, but this finding was not evident on statistical tests.


Endosonographic procedures are safe and highly specific in mediastinal restaging of lung cancer.

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