Supplementary Material for: Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy versus Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Disorders: A Meta-Analysis

Introduction: Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions.
Methods: A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed.
Results: The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p<0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p=0.0006) and benign disorder (87.62% vs. 60.00%, p＜0.0001).
Conclusion: This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications.

引言：支气管镜超声引导下经支气管纵隔冷冻活检（Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy，EBUS-TMC）作为一项新兴技术，近年研究显示其可提升支气管镜超声引导下经支气管针吸活检（EBUS-TBNA）对纵隔病变的诊断价值。现有文献表明，该术式相较传统EBUS-TBNA具有更优的诊断效能。本系统评价与荟萃分析旨在对比EBUS-TMC与EBUS-TBNA的诊断获取率及并发症发生情况，进而探讨这一新兴技术在提升纵隔病变诊断效能方面的应用潜力。
方法：本研究通过检索PubMed、Embase及Google Scholar数据库自建库至2023年12月31日发表的相关文献，开展全面系统的文献综述。本评价旨在评估EBUS-TMC在纵隔疾病诊断中的应用价值，并采用诊断性研究质量评价工具（QUADAS-2）对纳入的每项研究进行质量评估。诊断获取率的合并分析采用逆方差加权法进行荟萃分析，同时对该术式相关并发症进行全面分析。
结果：本荟萃分析共纳入10项研究，涉及538例患者。荟萃分析结果显示，EBUS-TMC的整体诊断率为89.59%（482/538），而EBUS-TBNA的诊断率为77.13%（415/538）。逆方差加权比值比为2.63（95%置信区间：1.86~3.72；p<0.0001），I²值为11%，表明两种术式间存在统计学显著性差异。两种术式的相关并发症包括气胸、纵隔气肿、纵隔炎及出血，其发生率分别为0.74%（4/538）、0.37%（2/538）、0.0%（0/538）及1.12%（6/538）。此外，漏斗图分析未发现明显的发表偏倚。进一步亚组分析显示，EBUS-TMC对淋巴瘤（86.36% vs. 27.27%，p=0.0006）及良性病变（87.62% vs. 60.00%，p<0.0001）的诊断价值均有显著提升。
结论：本项针对现有研究的综述结果表明，相较EBUS-TBNA，EBUS-TMC可提升整体诊断获取率，尤其在良性疾病与淋巴瘤的诊断方面优势显著，且未发生严重并发症。