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.