Diagnostic performances and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the older patients: a systematic review and meta-analysis

Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well-established for lung cancer diagnosis and staging, evidence in older patients remains limited. This study compared the diagnostic value and safety between older and younger groups. For this systematic review and meta-analysis, we conducted a comprehensive search across databases, including PubMed, Embase, and the Cochrane Central Register. Older patients were defined as ≥ 65 or ≥ 70 years, according to study-specific criteria, and younger patients as below these thresholds. A proportional meta-analysis was performed to estimate the pooled diagnostic yield of the EBUS-TBNA. We found six studies comprising 5,206 participants. The pooled diagnostic yield for overall diagnosis was similar between the older and younger patients (0.96 vs. 0.97; P = 0.81). The pooled diagnostic yield for malignancy detection was higher in the older patients than in the younger patients (0.59 vs. 0.51; P < 0.01). There was no significant difference in the overall complication rate between the two groups (risk ratio, 0.95; 95% confidence interval [CI], 0.74 1.23). The older group received a significantly lower average dose of midazolam compared to the younger group (mean difference [MD], − 1.11 mg; 95% CI, − 1.58 to − 0.63; P < 0.01). The duration of the procedure was comparable between the two groups (MD, − 0.03 min; 95% CI, − 1.44 1.38; P = 0.97). Our findings suggest that EBUS-TBNA can be safely and effectively performed in older patients, with diagnostic outcomes comparable to those in younger individuals.