Endosonography Versus Mediastinoscopy in Mediastinal Staging of Lung Cancer: Systematic Review and Meta-Analysis

Whether endosonography can replace mediastinoscopy as the initial procedure for mediastinal staging of non-small cell lung cancer remains controversial. Herein, we perform a systematic review of randomized controlled trials and observational studies (both procedures performed in same subjects) comparing the two procedures. Nine studies (960 subjects) were identified. The pooled risk-difference of the sensitivity of endosonography versus mediastinoscopy in observational studies and randomized controlled trials was 0.11 (95% confidence interval, -0.07 to 0.29) and 0.11 (95% confidence interval, -0.03 to 0.25), respectively suggesting equivalence of the two procedures. The complication rate was significantly lower with endosonographic procedures. Endoscopic ultrasound-guided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration was found to have similar yield but lower complication rate compared to mediastinoscopy in the initial mediastinal staging of non-small cell lung cancer.