Lung cancer is frequently diagnosed and staged with endobronchial ultrasonography and transbronchial needle aspiration (EBUS-TBNA). Molecular markers such as epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), reactive oxygen species proto-oncogene (ROS1), and programmed death-ligand 1 are becoming increasingly important in patients with lung cancer to identify targetable mutations suitable for personalized therapy (PD-L1). To see if EBUS-TBNA–derived tissue is suitable for molecular analysis. The data search, quality evaluation, and data extraction were all done by two independent reviewers. Researchers used the ROBINS-I method to assess the risk of bias in both prospective and retrospective research. The key outcome was the proportion of sufficient samples collected by EBUS-TBNA for molecular analysis. A binary random-effects model was used to pool the data. Finally, they used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to grade the evidence. 

The researchers looked at 33 trials with a total of 2,698 participants. The pooled likelihood of obtaining an adequate sample was 94.5% (95% confidence interval CI], 93.2–96.4%) in 28 studies that assessed EBUS-TBNA for the identification of EGFR mutations. The pooled chance of finding ALK mutations was 94.9% (95 % confidence interval: 89.4–98.8%). Finally, 15.8% of people had an EGFR mutation (95% confidence interval: 12.1–19.4%), while 2.77% had an ALK mutation (95% confidence interval: 1.0–4.8%). Meta-analysis of data for ROS1 and PD-L1 mutations was not possible. For molecular investigation of both EGFR and ALK mutations, EBUS-TBNA has a good yield. The suitability of TBNA samples for next-generation sequencing, on the other hand, is unknown and should be investigated further in future research.