Network meta-analysis compares endoscopic techniques for sarcoidosis diagnosis

This systematic review and network meta-analysis included 35 studies of patients with suspected sarcoidosis, comparing various endoscopic techniques for tissue sampling. The analysis did not report study phase, setting, or follow-up duration. The primary outcome was diagnostic yield, with comparisons made between different endoscopic approaches.

For diagnostic yield compared to transbronchial lung biopsy (TBLB), endobronchial ultrasound with intranodal forceps biopsy (EBUS-IFB) showed a relative risk of 3.50 (95% credible interval 2.14-5.84) and EBUS with transbronchial mediastinal cryobiopsy (EBUS-TMC) showed RR 3.52 (95% CrI 1.97-6.48). Absolute numbers were not reported. Using surface under the cumulative ranking curve (SUCRA) analysis, EBUS-IFB (0.912) and EBUS-TMC (0.910) ranked highest for diagnostic yield. Middle rankings included EBUS core needle biopsy (0.587), endoscopic ultrasound fine-needle aspiration (0.582), EBUS transbronchial needle aspiration (0.560), and EUS bronchoscope-guided FNA (0.498). Conventional TBNA (0.279), TBLB (0.168), and endobronchial biopsy (0.001) ranked lowest.

Safety data for adverse events, serious adverse events, and discontinuations were not reported, though the analysis noted all procedures had a favorable safety profile. Key limitations include low certainty of evidence across the network. The authors suggest EBUS-IFB and EBUS-TMC may offer superior diagnostic performance in centers with appropriate expertise, but clinical decisions should be individualized given the evidence limitations.