Efficacy and Safety of EBUS-TBNA and EUS-B-FNA in Children: A Systematic Review and Meta-analysis

Background: Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Transesophageal Bronchoscopic Ultrasound-guided fine-needle aspiration (EUS-B-FNA) are established modalities for evaluation of mediastinal/hilar lymphadenopathy in adults. Limited literature is available on the utility of these modalities in the pediatric population. Herein, we perform a systematic review and meta-analysis on the yield and safety of EBUS-TBNA and EUS-B-FNA in children. Methods: We performed a systematic search of the PubMed and EMBASE databases to extract the studies reporting the utilization of EBUS-TBNA/EUS-B-FNA in children (<18 years of age). Pooled diagnostic yield and sampling adequacy (proportions with 95% confidence intervals) were calculated using the random-effects model. Details of any procedure-related complications were noted. Results: The search yielded 12 relevant studies (five case series and seven case reports on EBUS-TBNA/EUS-B-FNA, 173 patients). Data from five case series (164 patients) were summarized for the calculation of sampling adequacy and diagnostic yield. Safety outcomes were extracted from all publications. The pooled sampling adequacy and combined diagnostic yield of EBUS TBNA/EUS-B-FNA were 98% (95% CI, 92-100%) and 61% (95% CI, 43-77%) respectively. A procedure-related major complication was reported in 1 patient (1/173, Major complication rate 0.6%), and minor complications occurred in 6 patients (6/173, Minor complication rate 3.5%). Conclusions: EBUS-TBNA and EUS-B-FNA are safe modalities for evaluation of mediastinal lymphadenopathy in the pediatric population. EBUS-TBNA/EUS-B-FNA may be considered as the first-line diagnostic modalities for this indication as they have a good diagnostic yield and can avoid the need for invasive diagnostic procedures.