| Background:EBUS-TBNA has become one of the most important methods for standard sampling of thoracic lymph nodes,which helps to stage thoracic enlarged lymph nodes caused by lung cancer and has important clinical therapeutic significance.This technology has advantages such as minimally invasive,safe,repeatable,high diagnostic accuracy,and low economic cost.It has been widely applied in clinical practice abroad and is gradually being developed in China.Ultrasound elastography imaging technology can make a preliminary judgment on the nature of the disease by evaluating the stiffness of the tissue and its stiffness distribution in the regions of interest.It has played a potential advantage in the diagnosis of lymph node disease.For the enlarged intrathoracic lymph nodes of unknown causes,the combination of EBUS-TBNA and ultrasonic elastography imaging technology can help to sample suspicious thoracic lymph nodes in a visualized state,effectively improving the accuracy of differential diagnosis of benign and malignant lymph nodes in the hilar and mediastinum,and has guiding significance for accurate staging and clinical treatment of lung cancer.Purpose:In previous studies,endobronchial ultrasound elastography has good diagnostic efficacy for intrathoracic lymph nodes,but there are significant differences in the specificity and sensitivity of diagnosis.This meta-analysis will summarize the studies that meet the inclusion criteria to comprehensively evaluate the value of endobronchial ultrasound elastography in the differential diagnosis of benign and malignant intrathoracic lymph nodes.Methods:Through comprehensive literature search on Pub Med,Embase,Web of Science,Scopus,Cochrane Library,Pro Quest,CNKI,Wanfang,Vip,CBM and other domestic and foreign databases.Rev Man5.3 software was used to evaluate the quality of each included study according to the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2),and the quality of the included literature was evaluated.Relevant differences were resolved through discussion.Extract the basic characteristics and four-grid datas of the studies,stata14.0 and Meta-Disc1.4 software test the heterogeneity and threshold effect of the included literature,and calculate the combined sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,summary receiver operator characteristic curve and the area under the curve,so as to comprehensively evaluate the diagnostic value of endobronchial ultrasound elastography for benign and malignant intrathoracic lymph nodes.If there is significant heterogeneity in the included articles,meta-regression analysis,sensitivity analysis and publication bias test are also needed to explore the source of heterogeneity.Results:A total of 23 studies were included,including 1860 patients and 3131 intrathoracic lymph nodes.The heterogeneity test results between the original studies showed that the I~2value of sensitivity was 83.00%,and the I~2value of specificity was 92.33%,indicating that the included studies had significant heterogeneity.The random effect model is used to merge the effect indicators,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of endobronchial ultrasound elastography in the diagnosis of intrathoracic lymph nodes were0.89(95%CI,0.84-0.92),0.81(95%CI,0.75-0.87),4.80(95%CI,3.48-6.63),0.13(95%CI,0.09-0.19),35.73(95%CI,21.55-59.25),respectively.In addition,the area under the summary receiver operator characteristic curve was 0.92(95%CI,0.90-0.94).The results of meta-regression analysis show that the heterogeneity of sensitivity may be related to the number of lymph nodes,the type of study,the reference of gold standard,the year of publication and the elastography imaging method.In terms of specificity,the number of lymph nodes,the elastography imaging method and the reference of gold standard may be the main sources of its heterogeneity.We removed single study one by one to observe whether the pooled sensitivity and specificity had significant changes.The sensitivity analysis showed that the pooled results were stable and reliable.Deek’s funnel plot further verified the publication bias between the original studies,which may be part of the source of heterogeneity.Conclusion:Intrabronchial ultrasound elastography combined with transbronchial ultrasound guided aspiration can significantly improve the accuracy of differential diagnosis of benign and malignant lymph nodes in the chest,and provide accurate histopathology basis for clinical treatment. |
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