Comparative diagnostic performance of advanced endoscopic techniques in suspected sarcoidosis: A systematic review and network meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with suspected sarcoidosis requiring tissue diagnosis |
| I — Intervention | Advanced endoscopic techniques (EBUS-IFB, EBUS-TMC, EBUS-CNB, EUS-FNA, EUS-B-FNA) |
| C — Comparator | Conventional techniques (TBLB, cTBNA, EBB) and other endoscopic approaches |
| O — Outcomes | Diagnostic yield (primary), safety profile (secondary) |
Bottom Line
This network meta-analysis suggests EBUS-guided intranodal forceps biopsy and transbronchial mediastinal cryobiopsy may offer superior diagnostic yield compared to conventional techniques like transbronchial lung biopsy in suspected sarcoidosis. However, the authors appropriately caution that evidence certainty is low, and clinical decisions should remain individualised. The 3.5-fold higher diagnostic yield is promising but requires validation in high-quality prospective studies. Australian clinicians should consider these findings alongside local expertise, patient factors, and established diagnostic pathways. The safety profile appears favourable across all techniques, but detailed complication data are lacking. While these advanced techniques show promise, their adoption should be gradual and evidence-based, particularly given the significant training and resource requirements for implementation.
Key Findings
P Value: Not reported
Effect Size: EBUS-IFB RR 3.50 vs TBLB; EBUS-TMC RR 3.52 vs TBLB
Primary Outcome: Diagnostic yield of endoscopic techniques
Nnt Or Sensitivity: SUCRA rankings: EBUS-IFB (0.912), EBUS-TMC (0.910) highest probability of being best
Confidence Interval: EBUS-IFB: 2.14-5.84; EBUS-TMC: 1.97-6.48
Clinical Application
Limited to centres with EBUS-IFB and EBUS-TMC capabilities; requires specialised training and equipment Relevant to Australian thoracic medicine practice; EBUS procedures covered under MBS items 30473-30476; aligns with TSANZ guidelines for sarcoidosis diagnosis Patients with suspected sarcoidosis requiring tissue diagnosis in centres with advanced endoscopic expertise
Abstract
BACKGROUND: While various endoscopic techniques are used for minimally invasive tissue sampling in suspected sarcoidosis, comprehensive evidence comparing their diagnostic efficacy is limited, and the optimal approach remains unclear. RESEARCH QUESTION: Which endoscopic technique provides the greatest diagnostic advantage for sarcoidosis? STUDY DESIGN AND METHODS: We systematically searched 3 databases for studies published up to 22 April 2025. A network meta-analysis was conducted within a Bayesian framework, with diagnostic yield as the primary outcome. RESULTS: A total of 35 studies were included. Compared to TBLB, both EBUS-guided intranodal forceps biopsy (EBUS-IFB) (RR 3.50, 2.14-5.84) and EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) (RR 3.52, 1.97-6.48) showed higher diagnostic yield. SUCRA rankings placed EBUS-IFB (0.912) and EBUS-TMC (0.910) at the top, followed by EBUS-guided core needle biopsy (EBUS-CNB) (0.587), EUS-FNA (0.582), and EBUS-TBNA (0.560), EUS-B-FNA (0.498). Conventional techniques, including cTBNA (0.279), TBLB (0.168), and EBB (0.001), ranked lowest. All procedures had a favourable safety profile. CONCLUSIONS: In centres with appropriate expertise, EBUS-IFB and EBUS-TMC may offer superior diagnostic performance for sarcoidosis. However, given the low certainty of evidence, these conclusions should be interpreted with caution. Clinical decisions should be individualised, considering the patient's condition when determining the final diagnostic strategy.
References
- 1.Li, S.-P., Luo, Y., Liu, X.-B., Zhang, Z.-M., & Bao, Y. (2026). Comparative diagnostic performance of advanced endoscopic techniques in suspected sarcoidosis: A systematic review and network meta-analysis. Pulmonology. https://doi.org/10.1080/25310429.2026.2647681
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