Results
The initial search yielded 238 study results. No previously published systematic review or meta-analysis on the subject was found. After initial screening, 14 eligible articles on EBUS-TBNA/EUS-B-FNA in children were identified. Twelve studies (including 173 patients) described the utilization of EBUS-TBNA or EUS-B-FNA in pediatric mediastinal lymphadenopathy. Two articles were excluded as one described utilization of EUS-B-FNA for intra-abdominal pathology, and one case report described the use of EBUS for airway wall involvement assessment in a patient with mucoepidermoid carcinoma. (8, 9) Of the finally selected 12 articles, five were case series that included greater than five patients, and seven were single patient case reports (except one article that described EBUS-TBNA in two children)(10). The abstracted data of the five major case series are summarized in Table 1. These five case series (including 164 children) were included in the meta-analysis for calculation of the pooled summary statistics for diagnostic yield and sampling adequacy. (11-15) In all, a total of 173 patients underwent EBUS-TBNA/EUS-B-FNA.
The five major case series included 164 patients (90 males, 54.9%). All the studies were retrospective in nature. Four out of the five were multicentric (except Gulla KM et al., India).(13) Two studies reported the use of only EBUS-TBNA(11, 15), two used both EBUS-TBNA and EUS-B-FNA(13, 14), while one study used Radial EBUS along with EBUS-TBNA.(12) For the study where both EBUS-TBNA and Radial EBUS were used, data is summarized for only the patients who underwent EBUS-TBNA. General anaesthesia (GA) was used in one study(12), three studies used both GA and moderate sedation(11, 14, 15), while in one study(13), procedures were performed only using moderate sedation. The most common EBUS bronchoscope used was the Olympus BF-UC-180F (6.9 mm outer diameter with a 2.2 mm working channel). 21G (13, 14) and 22G needle (11, 12) was used in two studies each. A total of 238 nodes were sampled. The most frequently sampled lymph node stations were Subcarinal (Station 7) and lower right paratracheal (Station 4R). Rapid On-Site Evaluation (ROSE) was performed in three of the five studies.(11, 12, 15) The mean procedure duration was 20 min (Range 18-30 min).(14)