Introduction
Mediastinal and hilar lymphadenopathy is a common clinical problem in
adults and children. (1) The traditional approach for the diagnosis of
mediastinal lymphadenopathy / mediastinal masses in children have
included various invasive techniques. These include procedures like
Mediastinoscopy, Video-Assisted Thoracoscopic Surgery (VATS),
Thoracotomy or Image-guided percutaneous biopsy. (2) However, these
modalities have inherent risks and potential for severe complications
due to the invasive nature of the procedure. (3)
Endobronchial Ultrasound-guided transbronchial needle aspiration
(EBUS-TBNA) has revolutionized the diagnostic approach of mediastinal
lymphadenopathy in adults. (4, 5) EBUS-TBNA involves the use of a
dedicated ultrasound equipped bronchoscope that enables real-time
sampling from mediastinal and hilar lymph nodes. The EBUS bronchoscope
can also be introduced through the oesophagus to sample mediastinal
lymph nodes. This technique is described as Transesophageal
Bronchoscopic Ultrasound-guided fine-needle aspiration (EUS-B-FNA). (6)
While these techniques were initially developed for diagnosis and
staging of lung cancer, their application has now extended for the
determination of various benign diseases as well.
The first report of EBUS-TBNA in children in 2009 followed the initial
description of EBUS-TBNA in 2003. (7) Since then, few studies reporting
the utilization of EBUS-TBNA and EUS-B-FNA in children have been
published. Most of the studies in children include retrospective case
series and case reports that have reported a variable diagnostic yield
and peculiar issues related to the procedure in children. The benefit of
these minimally invasive modalities over the invasive approaches has
also been highlighted. In this systematic review, we summarize the
various studies describing the utility and safety of EBUS TBNA/EUS-B-FNA
in children. We also perform a meta-analysis of the relevant studies to
calculate the diagnostic yield and sampling adequacy of these modalities
in the pediatric population.