Introduction. Endobronchial ultrasound (EBUS) is a procedure that provides access to the mediastinal staging; however, EBUS\ncannot be used to stage all of the nodes in the mediastinum. In these cases, endoscopic ultrasound (EUS) is used for complete\nstaging. Objective. To provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing\nmediastinal staging. Methods. Systematic review and meta-analysis to evaluate the diagnostic yield of EBUS + EUS compared with\nsurgical staging. Two researchers performed the literature search, quality assessments, data extractions, and analyses.We produced\na meta-analysis including sensitivity, specificity, and likelihood ratio analysis. Results. Twelve primary studies (1515 patients) were\nincluded; two were randomized controlled trials (RCTs) and ten were prospective trials. The pooled sensitivity for combined EBUS\n+ EUS was 87% (CI 84ââ?¬â??89%) and the specificity was 99% (CI 98ââ?¬â??100%). For EBUS + EUS performed with a single bronchoscope\ngroup, the sensitivity improved to 88% (CI 83.1ââ?¬â??91.4%) and specificity improved to 100% (CI 99-100%). Conclusion. EBUS + EUS\nis a highly accurate and safe procedure. The combined procedure should be considered in selected patients with lymphadenopathy\nnoted at stations that are not traditionally accessible with conventional EBUS.
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