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pronto se demostr&#243; tambi&#233;n su utilidad en otras patolog&#237;as neopl&#225;sicas y granulomatosas que producen afectaci&#243;n mediast&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a>&#46; Adem&#225;s de evitar la realizaci&#243;n de pruebas m&#225;s invasivas&#44; ha supuesto una influencia positiva sobre los tiempos diagn&#243;sticos y una mejor relaci&#243;n coste-efectividad en el diagn&#243;stico y la estadificaci&#243;n del c&#225;ncer de pulm&#243;n<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">5-8</span></a>&#46; Hay tambi&#233;n evidencias sobre su posible papel en el drenaje de lesiones qu&#237;sticas mediast&#237;nicas o pleuroperic&#225;rdicas<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; o para la valoraci&#243;n de patolog&#237;a vascular pulmonar<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El n&#250;mero de publicaciones que avalan la efectividad y la seguridad de esta t&#233;cnica se ha incrementado de forma exponencial &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Existen en el momento actual numerosos metaan&#225;lisis y revisiones sistem&#225;ticas&#44; estudios aleatorizados&#44; de cohortes&#44; de casos y controles&#44; series de casos y una ingente cantidad de revisiones narrativas que abordan diversos aspectos sobre la efectividad&#44; la eficiencia y la seguridad de esta t&#233;cnica&#46; En los &#250;ltimos 5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; muchos de los estudios asocian la efectividad de la EBUS-TBNA a la de la <span class="elsevierStyleItalic">transoEsophageal UltraSonography-guided Fine Needle Aspiration</span> &#40;EUS-FNA&#41; a trav&#233;s de la utilizaci&#243;n de 2 dispositivos diferentes&#44; o bien utilizando un solo dispositivo&#44; el ecobroncoscopio lineal&#44; para realizar el estudio de las lesiones accediendo tanto desde la v&#237;a a&#233;rea como desde el es&#243;fago &#40;EUS-B&#41;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">12-15</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">En este contexto&#44; parece pues oportuno ordenar y resumir la evidencia cient&#237;fica sobre la efectividad y la eficiencia de los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os de pr&#225;ctica cl&#237;nica de la EBUS lineal&#44; especialmente en las indicaciones m&#225;s aceptadas<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para ello se ha realizado una exhaustiva y ordenada revisi&#243;n de todas las publicaciones incluidas en las bases de datos MEDLINE y EMBASE en relaci&#243;n con la EBUS lineal hasta abril de 2015&#44; present&#225;ndose fundamentalmente en forma de tablas&#46; Estas resumen las caracter&#237;sticas y los resultados de los metaan&#225;lisis y&#44; en su ausencia&#44; de todos los estudios controlados o de otro tipo que abordan espec&#237;ficamente una patolog&#237;a determinada&#46; En ellas se han incluido las variables que permiten al lector una evaluaci&#243;n global pero sencilla de la evidencia cient&#237;fica disponible sobre esta prueba diagn&#243;stica&#44; incluyendo la sensibilidad &#40;S&#41;&#44; la especificidad &#40;E&#41; y las razones de probabilidad positiva &#40;RPP&#41; y negativa &#40;RPN&#41;&#44; calculadas por los autores de esta revisi&#243;n en muchos casos&#44; ya que al no ser dependientes de la prevalencia permiten una mejor comparaci&#243;n entre los diferentes estudios que los valores predictivos<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; En los metaan&#225;lisis se ha incluido el &#237;ndice I<span class="elsevierStyleSup">2</span>&#44; que refleja el porcentaje total de variaci&#243;n de los resultados que se debe a la heterogeneidad de los estudios y no al azar&#44; de forma que cuanto m&#225;s se aproxime su valor al 100&#37;&#44; mayor ser&#225; la heterogeneidad de los trabajos incluidos<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">18</span></a>&#46; Finalmente&#44; se resume la evidencia actual en relaci&#243;n con la seguridad y el an&#225;lisis de coste-efectividad de esta t&#233;cnica&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">De forma deliberada&#44; en esta revisi&#243;n no se han incluido estudios dise&#241;ados para analizar aspectos t&#233;cnicos de la EBUS-TBNA o del procesado o valor de las muestras para estudios moleculares&#46; Sobre esto hay excelentes revisiones narrativas o documentos de consenso recientes<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">EBUS-TBNA en el diagn&#243;stico y estadificaci&#243;n del c&#225;ncer de pulm&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">La estadificaci&#243;n es una parte capital de la evaluaci&#243;n de todo paciente con c&#225;ncer de pulm&#243;n&#44; adquiriendo un papel crucial a la hora de identificar la invasi&#243;n maligna del mediastino en el c&#225;ncer de pulm&#243;n no microc&#237;tico &#40;CPNM&#41;&#46; En las gu&#237;as de pr&#225;ctica cl&#237;nica sobre diagn&#243;stico y estadificaci&#243;n mediast&#237;nica del c&#225;ncer de pulm&#243;n&#44; la EBUS-TBNA se considera una herramienta clave<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">21-23</span></a>&#44; avalada por multitud de trabajos&#46; La mayor&#237;a de ellos han sido incluidos en los 6 metaan&#225;lisis publicados hasta el momento<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">3&#44;4&#44;12&#44;13&#44;21&#44;24</span></a>&#44; de los que 3 consideran &#250;nicamente estudios sobre la EBUS-TBNA asociada al uso de la EUS<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">12&#44;13&#44;21</span></a>&#46; Las caracter&#237;sticas y los resultados de los mismos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; en la que se evidencia una elevada validez diagn&#243;stica del estudio endosonogr&#225;fico mediast&#237;nico en pacientes con c&#225;ncer de pulm&#243;n con un indudable valor en la toma de decisiones&#44; m&#225;xima en el caso de resultados positivos&#44; pero muy importante tambi&#233;n en los negativos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En los 4 trabajos en los que se analiz&#243; este aspecto&#44; se detect&#243; una marcada heterogeneidad de los estudios incluidos&#44; debido a las diferencias en las pruebas de referencia utilizadas&#44; m&#233;todos de selecci&#243;n&#44; dise&#241;o de los estudios&#44; prevalencia de la enfermedad&#44; variabilidad en la t&#233;cnica y procedimiento&#44; experiencia o posibilidad de valoraci&#243;n in situ por pat&#243;logos de los centros participantes<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Aunque individualmente en los metaan&#225;lisis que analizan de forma conjunta el uso de EBUS-TBNA y EUS-FNA se demuestra una mayor S para la estrategia combinada frente a la EBUS-TBNA&#44; al comparar directamente la S que se obtiene en los distintos trabajos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; esto no parece observarse&#44; lo que deja abierto el debate sobre si es necesaria la combinaci&#243;n de ambas t&#233;cnicas de forma sistem&#225;tica&#46; Alg&#250;n estudio espec&#237;fico muy reciente inclina la balanza hacia el estudio combinado&#44; empezando con la EBUS-TBNA como primer procedimiento<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La comparaci&#243;n directa de forma ciega entre la EBUS-TBNA y la mediastinoscopia&#44; realizadas ambas en todos los pacientes y en diferentes escenarios&#44; ha demostrado una eficacia diagn&#243;stica superior o al menos similar de la primera en los 3 estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26-28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 1S&#44; Suplemento Online</a>&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">M&#225;s que la comparaci&#243;n entre las diferentes t&#233;cnicas&#44; las cuestiones clave en el momento actual parecen la elecci&#243;n de la adecuada secuencia de ellas y la necesidad de la confirmaci&#243;n de resultados negativos obtenidos por las t&#233;cnicas endosonogr&#225;ficas&#46; El estudio ASTER<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> fue el primer ensayo aleatorizado y multic&#233;ntrico que compar&#243; la estadificaci&#243;n mediast&#237;nica quir&#250;rgica con la ecoendosc&#243;pica completa&#44; seguida de la quir&#250;rgica si la primera era negativa&#44; en pacientes con CPNM con adenopat&#237;as mediast&#237;nicas de di&#225;metro superior a 10<span class="elsevierStyleHsp" style=""></span>mm en la TC o con PET positivo &#40;mediastino anormal por imagen&#41; y en casos de tumores centrales o sospecha de afectaci&#243;n N1 &#40;mediastino normal por imagen&#44; pero sospecha elevada de N2 oculto&#41;&#46; La S para el diagn&#243;stico de met&#225;stasis ganglionares fue del 79&#37; para la estadificaci&#243;n quir&#250;rgica y del 94&#37; para la ecoendosc&#243;pica&#44; seguida de la quir&#250;rgica si la primera era negativa&#46; Un an&#225;lisis posterior del estudio ASTER<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">29</span></a> aplicando metodolog&#237;a bayesiana demostr&#243; que la probabilidad posprueba de detecci&#243;n de adenopat&#237;as malignas no aumenta con el abordaje endosonogr&#225;fico seguido del quir&#250;rgico frente al primero exclusivamente cuando el mediastino es normal por imagen &#40;9&#37; en ambos casos&#41;&#44; pero s&#237; en los casos de mediastino anormal por imagen &#40;5&#37; vs&#46; 20&#37;&#41;&#44; lo que sugiere que solo deber&#237;an confirmarse quir&#250;rgicamente los resultados negativos en este caso&#46; Sin embargo&#44; estos datos no han sido reproducidos en el estudio ASTER<span class="elsevierStyleHsp" style=""></span>2&#44; que incluy&#243; pacientes con CPNM con sospecha cl&#237;nica de afectaci&#243;n ganglionar hiliar<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a>&#44; lo que parece mantener abierto el debate de la necesidad de confirmaci&#243;n quir&#250;rgica de resultados negativos cuando la probabilidad preprueba es baja o moderada&#46; Diferentes estudios han demostrado que incluso con alteraciones en la TC o la PET la fiabilidad de los resultados negativos de la EBUS-TBNA var&#237;an mucho en funci&#243;n de una amplia serie de variables que dependen de caracter&#237;sticas de la neoplasia &#40;tipo&#44; localizaci&#243;n&#44; estadio&#44; tama&#241;o&#41;&#44; de las adenopat&#237;as &#40;localizaci&#243;n&#44; caracter&#237;sticas ecogr&#225;ficas&#44; tama&#241;o&#44; avidez en la PET&#41;&#44; del procedimiento &#40;n&#250;mero de pases&#44; cantidad y localizaci&#243;n de las estaciones muestreadas&#44; tipo de sedaci&#243;n&#41;&#44; de la experiencia de los endoscopistas y pat&#243;logos&#44; y de la calidad de la muestra obtenida<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">31&#44;32</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las gu&#237;as de pr&#225;ctica cl&#237;nica m&#225;s recientes&#44; como la de la <span class="elsevierStyleItalic">American College of Chest Phisicians</span> &#40;ACCP&#41;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a>&#44; la de la Sociedad Espa&#241;ola de Patolog&#237;a Respiratoria &#40;SEPAR&#41;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a> y la de la <span class="elsevierStyleItalic">European Society of Thoracic Surgeons</span> &#40;ESTS&#41;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">23</span></a>&#44; coinciden en incluir la EBUS-TBNA &#40;con&#47;sin EUS&#41; como primera t&#233;cnica para la confirmaci&#243;n de la afectaci&#243;n mediast&#237;nica del CPNM&#46; Sin embargo&#44; entre ellas existen aspectos poco definidos o incluso diferentes en la recomendaci&#243;n de la confirmaci&#243;n de los resultados negativos o en las indicaciones de estudio mediante EBUS-TBNA en pacientes con mediastino normal por imagen &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 2S Suplemento Online</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El valor de la EBUS-TBNA queda reforzado en un reciente estudio multic&#233;ntrico aleatorizado que demuestra que esta influye de forma favorable en los tiempos de diagn&#243;stico y estadificaci&#243;n y la supervivencia de los pacientes con CPNM<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">7</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">EBUS-TBNA en la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n no microc&#237;tico tras tratamiento de inducci&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hasta el momento se han publicado 5 estudios espec&#237;ficos con esta indicaci&#243;n y que incluyen en total a 363 pacientes con estadios histol&#243;gicos IIIA por N2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">33-37</span></a>&#46; Tres de ellos son estudios retrospectivos y de limitada casu&#237;stica&#44; con una marcada variabilidad en la prevalencia de afectaci&#243;n ganglionar mediast&#237;nica &#40;entre el 20 y el 88&#37;&#41; y el valor predictivo negativo de la EBUS-TBNA &#40;entre el 22 y el 94&#37;&#41;&#44; m&#225;s alto en los casos de menor incidencia de enfermedad N2 tras el tratamiento&#46; De forma general&#44; en comparaci&#243;n con su valor en la estadificaci&#243;n inicial del CPNM&#44; la EBUS-TBNA presenta en estos casos una S global m&#225;s baja&#44; una E y una RPP similares&#44; salvo en uno de los trabajos&#44; y una RPN que hace que la probabilidad posprueba pueda seguir siendo alta tras un resultado negativo&#46; Solo en el estudio de Szlubowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">37</span></a> se analiz&#243; la eficacia conjunta de la EBUS y el EUS&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">EBUS-TBNA en el diagn&#243;stico de masas intrapulmonares</span><p id="par0070" class="elsevierStylePara elsevierViewall">La EBUS-TBNA se ha utilizado frecuentemente para el diagn&#243;stico de pacientes con lesiones centrales&#44; paratraqueales o paraesof&#225;gicas no adenop&#225;ticas y sin afectaci&#243;n endobronquial&#44; muchas veces tras otros estudios broncosc&#243;picos negativos<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">38</span></a>&#46; Se han publicado 8 trabajos espec&#237;ficos&#44; casi todos series de casos retrospectivas&#44; que incluyen un total de 393 pacientes a los que se les realiz&#243; una EBUS-TBNA con esta indicaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">39-46</span></a>&#46; De forma general&#44; la t&#233;cnica parece mostrar una alta S&#44; en la mayor&#237;a de los casos superior al 90&#37;&#46; La E &#250;nicamente se describe en 3 de ellos&#44; en los que es del 100&#37;&#44; resultando una RPN que reduce de forma considerable la probabilidad preprueba&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">EBUS-TBNA en el diagn&#243;stico de neoplasias extrator&#225;cicas</span><p id="par0075" class="elsevierStylePara elsevierViewall">Hasta un 30&#37; de tumores extrapulmonares pueden producir afectaci&#243;n de ganglios mediast&#237;nicos o hiliares&#46; En un metaan&#225;lisis reciente<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">47</span></a> del valor de la EBUS-TBNA con esta indicaci&#243;n&#44; en el que se incluyen 6 estudios &#40;533 pacientes&#41;&#44; la S agrupada fue del 85&#37;&#44; la E del 99&#37;&#44; la RPP de 28&#44;6 y la RPN de 0&#44;16&#46; Los tumores primarios m&#225;s frecuentes incluidos fueron&#58; cabeza y cuello&#44; colorrectal&#44; mama&#44; renal&#44; esof&#225;gico&#44; g&#225;strico&#44; prost&#225;tico y melanoma&#46; Dos estudios posteriores a este an&#225;lisis<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;49</span></a> demostraron resultados similares&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">EBUS-TBNA en el diagn&#243;stico del linfoma</span><p id="par0080" class="elsevierStylePara elsevierViewall">El valor de la EBUS para estudiar la afectaci&#243;n mediast&#237;nica en procesos linfoproliferativos es la indicaci&#243;n de mayor controversia de las descritas en la presente revisi&#243;n&#44; dada la heterogeneidad de los estudios publicados<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">50</span></a>&#46; Se han publicado 7 trabajos espec&#237;ficos para el diagn&#243;stico de linfomas&#44; que incluyen 341 pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">51-57</span></a>&#46; El tama&#241;o muestral y la prevalencia son variables &#40;entre el 10 y el 66&#37;&#41; y los datos de validez y exactitud diagn&#243;stica que aportan son pobres en la mayor&#237;a&#44; con una S muy diferente entre los estudios&#44; aunque claramente mejor en los casos de recurrencias que en los linfomas primarios&#44; y una RPN que obligar&#237;a a confirmar los negativos&#46; En alguno de los trabajos&#44; el estudio mediante t&#233;cnicas de citometr&#237;a de flujo y la valoraci&#243;n inmediata por un pat&#243;logo o por comit&#233;s multidisciplinares podr&#237;an ayudar a mejorar la validez de la t&#233;cnica<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">53&#44;55&#44;56</span></a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">EBUS-TBNA en el diagn&#243;stico de la sarcoidosis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Tras el c&#225;ncer de pulm&#243;n&#44; es en el estudio de la sarcoidosis donde m&#225;s evidencia existe sobre el papel de la EBUS-TBNA&#46; Disponemos de 2 metaan&#225;lisis recientes&#46; El primero&#44; de Agarwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">58</span></a>&#44; incluye a una poblaci&#243;n seleccionada con alta sospecha previa de sarcoidosis &#40;prevalencia<span class="elsevierStyleHsp" style=""></span>&#8776;<span class="elsevierStyleHsp" style=""></span>80&#37;&#41;&#44; mientras que el segundo&#44; realizado por Trisolini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">59</span></a>&#44; minimiza el sesgo de selecci&#243;n al analizar estudios que inclu&#237;an pacientes con sospecha por t&#233;cnicas de imagen de adenopat&#237;as patol&#243;gicas&#44; independientemente de la sospecha etiol&#243;gica subyacente &#40;prevalencia<span class="elsevierStyleHsp" style=""></span>&#8776;<span class="elsevierStyleHsp" style=""></span>15&#37;&#41;&#46; El primero re&#250;ne un total de 533 pacientes en 15 estudios&#44; mientras que el segundo incluye 2&#46;097 pacientes en 14 publicaciones&#44; con 3 estudios que se hallan incluidos en ambos&#46; La eficacia diagn&#243;stica fue del 79&#37; para ambos&#46; En el segundo metaan&#225;lisis la S diagn&#243;stica fue del 85&#37;&#44; con una RPN del 0&#44;16&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Existen tambi&#233;n un importante n&#250;mero de publicaciones en las que se compara la EBUS-TBNA &#40;con&#47;sin EUS-FNA&#41; con otras t&#233;cnicas convencionales para el estudio de sarcoidosis como la TBNA convencional &#40;TBNAc&#41; y la biopsia transbronquial &#40;BTB&#41;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">60</span></a>&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se resumen los datos de los 10 estudios disponibles hasta el momento&#44; la mayor&#237;a prospectivos o controlados&#44; que incluyen un total de 835 pacientes<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46; Aunque la EBUS-TBNA en la mayor&#237;a de ellos aporta una mayor rentabilidad diagn&#243;stica que la TBNAc o la BTB&#44; las diferencias son menores en los estadios<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">i</span> para la TBNAc&#44; sobre todo en adenopat&#237;as de tama&#241;o superior a 15<span class="elsevierStyleHsp" style=""></span>mm y en estaciones paratraqueales derechas o subcarinales&#44; y en los estadios<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">ii</span> para la BTB<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46; La adici&#243;n sistem&#225;tica de la EUS-FNA y de las t&#233;cnicas convencionales potencia de forma importante su valor diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">EBUS-TBNA en el diagn&#243;stico de tuberculosis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se han publicado 6 estudios que de forma espec&#237;fica analizan el papel de la EBUS-TBNA para el diagn&#243;stico de tuberculosis que se presentan con adenopat&#237;as mediast&#237;nicas o hiliares &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">70-75</span></a>&#46; Estos trabajos&#44; que incluyen algo m&#225;s de 550 pacientes&#44; son en su mayor&#237;a series de casos de centros individuales&#44; salvo uno de ellos&#44; que es un estudio multic&#233;ntrico<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">71</span></a>&#46; La S y la RPN son muy variables &#40;con una E y una RPP similares&#41;&#44; y en varios de ellos mejoran de forma significativa al combinarse el estudio citol&#243;gico con el adecuado procesado microbiol&#243;gico convencional o por t&#233;cnicas moleculares<a class="elsevierStyleCrossRefs" href="#bib0805"><span class="elsevierStyleSup">74&#44;75</span></a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Coste-efectividad de la EBUS-TBNA</span><p id="par0100" class="elsevierStylePara elsevierViewall">Casi exclusivamente centrados en el c&#225;ncer de pulm&#243;n&#44; de forma general podr&#237;amos incluir 3 tipos de estudios&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los primeros estar&#237;an basados en la aplicaci&#243;n de modelos probabil&#237;sticos te&#243;ricos en funci&#243;n de los resultados previamente publicados encaminados a reducir los costes y a determinar la estrategia m&#225;s econ&#243;mica entre las alternativas disponibles &#40;t&#233;cnicas de imagen&#44; endosc&#243;picas o quir&#250;rgicas&#41;&#44; como el que se incluye en las gu&#237;as NICE de 2011 para el diagn&#243;stico y tratamiento del c&#225;ncer de pulm&#243;n<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a>&#44; o el estudio de un grupo dan&#233;s<a class="elsevierStyleCrossRef" href="#bib0820"><span class="elsevierStyleSup">77</span></a>&#44; con resultados favorables en general hacia la estrategia que combina PET y EBUS-TBNA&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El segundo tipo de estudios ser&#237;an aquellos de coste-beneficio en los que&#44; bas&#225;ndose en la propia experiencia o en la publicada&#44; se realizan an&#225;lisis econ&#243;micos directos de minimizaci&#243;n de los costes de la aplicaci&#243;n de la EBUS-TBNA a cohortes reales o hipot&#233;ticas de pacientes con c&#225;ncer de pulm&#243;n frente a otras estrategias convencionales o quir&#250;rgicas de diagn&#243;stico y estadificaci&#243;n&#46; Existen al menos 7 estudios de 5 pa&#237;ses distintos en esta l&#237;nea<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">8&#44;78-83</span></a>&#44; resultando en 6 de ellos favorables a la EBUS-TBNA&#44; con una variaci&#243;n importante en los costes evitados en funci&#243;n del dise&#241;o del estudio y del sistema sanitario de cada pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 3S Suplemento Online</a>&#41;&#46; En el &#250;nico en el que los costes de la mediastinoscopia fueron discretamente menores que los de la EBUS-TBNA&#44; esta se realizaba en quir&#243;fano y con anestesia general<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El &#250;ltimo grupo ser&#237;an estudios de coste-efectividad relacionados con la calidad de vida y la supervivencia&#44; como el que se realiz&#243; en la cohorte de pacientes incluida en el ASTER<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a>&#44; realizado en el Reino Unido&#44; Holanda y B&#233;lgica&#46; Los resultados fueron favorables a la EBUS-TBNA&#44; que supone menores costes globales y mejor calidad de vida de los pacientes que las t&#233;cnicas quir&#250;rgicas&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Complicaciones de la EBUS-TBNA</span><p id="par0120" class="elsevierStylePara elsevierViewall">Debido a la importante expansi&#243;n de esta t&#233;cnica en la &#250;ltima d&#233;cada&#44; progresivamente se fueron comunicando de forma individual o agrup&#225;ndolos en peque&#241;as series de casos distintas complicaciones secundarias a la realizaci&#243;n de este procedimiento&#44; en la mayor parte de los casos escasas y de baja gravedad&#46; Hemos encontrado 3 trabajos que permiten extraer una informaci&#243;n global sobre la seguridad de esta t&#233;cnica&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La revisi&#243;n sistem&#225;tica de Von Bartheld et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a>&#44; que incluy&#243; a un total de 9&#46;119 pacientes&#44; describe un 0&#44;14&#37; de complicaciones graves&#44; siendo las infecciosas y el neumot&#243;rax las m&#225;s prevalentes &#40;ambos del 0&#44;02&#37;&#41;&#44; de forma predominante en pacientes con lesiones qu&#237;sticas y sarcoidosis&#44; sin describir ning&#250;n fallecimiento&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Asano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a>&#44; en una encuesta nacional llevada a cabo en Jap&#243;n sobre la realizaci&#243;n de la EBUS a 7&#46;345 pacientes&#44; refieren una prevalencia de complicaciones graves del 1&#44;23&#37;&#44; siendo la m&#225;s frecuente el sangrado &#40;0&#44;68&#37;&#41;&#44; seguido de las complicaciones infecciosas &#40;mediastinitis&#44; abscesos&#8230;&#41; en un 0&#44;17&#37;&#44; de insuficiencia respiratoria &#40;0&#44;07&#37;&#41;&#44; y por &#250;ltimo de neumot&#243;rax &#40;0&#44;03&#37;&#41;&#46; Se registr&#243; un fallecimiento&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; el registro prospectivo AQUIRE<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a> en 6 hospitales de Estados Unidos encuentra en 1&#46;317 pacientes una incidencia de complicaciones graves del 1&#44;44&#37;&#44; siendo en su mayor&#237;a neumot&#243;rax &#40;0&#44;53&#37;&#41;&#44; seguido de insuficiencia respiratoria &#40;0&#44;23&#37;&#41; y de sangrado &#40;0&#44;2&#37;&#41;&#44; con un fallecimiento&#46; En este estudio se inclu&#237;an tambi&#233;n t&#233;cnicas convencionales&#44; como la BTB&#44; que fue un factor de riesgo independiente para el desarrollo de complicaciones&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusiones</span><p id="par0140" class="elsevierStylePara elsevierViewall">En funci&#243;n de lo descrito en la presente revisi&#243;n&#44; parece que la EBUS-TBNA es una t&#233;cnica segura&#44; coste-efectiva y con una elevada validez diagn&#243;stica para el diagn&#243;stico y la estadificaci&#243;n mediast&#237;nica de pacientes con sospecha o confirmaci&#243;n de c&#225;ncer de pulm&#243;n&#44; con un grado de evidencia alto&#46; Sin embargo&#44; se precisa un mayor n&#250;mero de estudios que nos ayuden en la toma de decisiones ante un resultado negativo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La evidencia disponible sobre el papel de la EBUS-TBNA en el diagn&#243;stico de sarcoidosis y neoplasias extrator&#225;cicas tambi&#233;n es elevada&#44; pero mucho menor cuando la t&#233;cnica se emplea para el estudio de tuberculosis&#44; de linfoma y para la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras quimioterapia neoadyuvante&#46; No obstante&#44; por su alta seguridad y menor invasividad que las t&#233;cnicas quir&#250;rgicas&#44; el grado de recomendaci&#243;n para emplear la EBUS-TBNA como la prueba diagn&#243;stica inicial en estas patolog&#237;as parece muy alto en la mayor&#237;a de los casos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses en relaci&#243;n con los contenidos del presente manuscrito&#46;</p></span></span>"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico y estadificaci&#243;n del c&#225;ncer de pulm&#243;n"
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          "titulo" => "EBUS-TBNA en la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n no microc&#237;tico tras tratamiento de inducci&#243;n"
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          "identificador" => "sec0020"
          "titulo" => "EBUS-TBNA en el diagn&#243;stico de masas intrapulmonares"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de neoplasias extrator&#225;cicas"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico del linfoma"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de la sarcoidosis"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de tuberculosis"
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          "titulo" => "Coste-efectividad de la EBUS-TBNA"
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          "titulo" => "Complicaciones de la EBUS-TBNA"
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    "fechaRecibido" => "2015-07-21"
    "fechaAceptado" => "2015-08-26"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La <span class="elsevierStyleItalic">real-time EndobroBronchial UltraSound-guided TransBronchial Needle Aspiration</span> &#40;EBUS-TBNA&#41; ha supuesto uno de los principales hitos en la historia de la broncoscopia&#46; En los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os de utilizaci&#243;n se han publicado una ingente cantidad de art&#237;culos de todo tipo sobre el procedimiento y los resultados de esta t&#233;cnica que han avalado su utilizaci&#243;n en el estudio de diversas lesiones mediast&#237;nicas y pulmonares&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En el presente art&#237;culo se realiza una exhaustiva y ordenada revisi&#243;n de toda la evidencia cient&#237;fica disponible sobre sus indicaciones m&#225;s generalizadas&#44; mediante la descripci&#243;n de las caracter&#237;sticas y los resultados de los estudios espec&#237;ficos sobre su eficacia&#44; seguridad y coste-efectividad disponibles hasta el momento&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este an&#225;lisis demuestra que la EBUS-TBNA es una t&#233;cnica segura&#44; coste-efectiva y con una elevada validez diagn&#243;stica para el diagn&#243;stico y la estadificaci&#243;n mediast&#237;nica de pacientes con sospecha o confirmaci&#243;n de c&#225;ncer de pulm&#243;n&#44; con un grado de evidencia alto&#46; Sin embargo&#44; se precisa de un mayor n&#250;mero de estudios que nos ayuden en la toma de decisiones ante un resultado negativo&#46; La evidencia disponible sobre el papel de la EBUS-TBNA en el diagn&#243;stico de sarcoidosis y neoplasias extrator&#225;cicas tambi&#233;n es elevada&#44; pero mucho menor cuando la t&#233;cnica se emplea para el estudio de tuberculosis y de linfoma y para la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras quimioterapia neoadyuvante&#46; No obstante&#44; por su alta seguridad y menor invasividad que las t&#233;cnicas quir&#250;rgicas&#44; el grado de recomendaci&#243;n para emplear la EBUS-TBNA como la prueba diagn&#243;stica inicial en estas patolog&#237;as parece muy alto en la mayor&#237;a de los casos&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Real-time endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; is one of the major landmarks in the history of bronchoscopy&#46; In the 10<span class="elsevierStyleHsp" style=""></span>years since it was introduced&#44; a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This article is a comprehensive&#44; systematic review of all the available scientific evidence on the more general indications for this technique&#46; Results of specific studies on efficacy&#44; safety and cost-effectiveness available to date are examined&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The analysis shows that EBUS-TBNA is a safe&#44; cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer&#46; However&#44; more studies are needed to guide decision-making in the case of a negative result&#46; Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high&#44; but much lower when used in the study of tuberculosis&#44; lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy&#46; Nevertheless&#44; due to its good safety record and lack of invasiveness compared to surgical techniques&#44; the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases&#46;</p></span>"
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            "etiqueta" => "Anexo A"
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          "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de referencias bibliogr&#225;ficas en Pubmed sobre EBUS desde el a&#241;o 2000 a 2014&#46;</p>"
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; I<span class="elsevierStyleSup">2</span>&#58; &#237;ndice I al cuadrado&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Estudios &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">I<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Adams&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Gu&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">74&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Dong&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">1&#46;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">0&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">87&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Silvestri&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">2&#46;756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Silvestri&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">811&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Zhang&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">12</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">75&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Dhooria&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">1&#46;080&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab981288.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Combinado con EUS-FNA&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los metaan&#225;lisis sobre el valor de la EBUS-TBNA en el diagn&#243;stico y estadificaci&#243;n del c&#225;ncer de pulm&#243;n</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ECA&#58; estudio controlado aleatorizado&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Herth&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Szlubowski&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zielinsky&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasir&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Szlubowski&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab981286.png"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras tratamiento de inducci&#243;n con quimioterapia</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nakajima&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tournoy&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhao&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lourido&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bhatti&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Verma&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bugalho&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dincer&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981289.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en el estudio pacientes con masas intrapulmonares</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; P&#58; linfoma primario&#59; R&#58; recurrencia de linfoma&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad &#40;incluye diagn&#243;stico y tipificaci&#243;n&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kennedy&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steinfort&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Marshall&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iqbal&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 en P55 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ko&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moonim&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 en P100 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Talebian-Yazdi&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 en P88 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981287.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en el estudio pacientes con linfoma</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BTB&#58; biopsia transbronquial&#59; ECA&#58; estudio controlado aleatorizado&#59; BNAc&#58; punci&#243;n transbronquial convencional&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidad</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TBNAc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BTB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EBUS-TBNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oki&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nakajima&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tremblay&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Navani&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plit&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Von Bartheld&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">304&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oki&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gupta&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66-73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Li&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">68</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gnass&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">69</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que comparan la validez diagn&#243;stica de la EBUS-TBNA con otras t&#233;cnicas broncosc&#243;picas convencionales en la sarcoidosis</p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sun&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">72</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ren&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">73</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Geake&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0810"><span class="elsevierStyleSup">75</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Convex probe endobronchial ultrasound"
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                      "doi" => "10.1055/s-0034-1395498"
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                        "tituloSerie" => "Semin Respir Crit Care Med&#46;"
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                        "volumen" => "35"
                        "paginaInicial" => "636"
                        "paginaFinal" => "644"
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                          0 => array:2 [ …2]
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration&#58; A systematic review"
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                          "etal" => false
                          "autores" => array:3 [ …3]
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                    0 => array:2 [
                      "doi" => "10.1183/09031936.00097908"
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                        "tituloSerie" => "Eur Respir J&#46;"
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                        "volumen" => "33"
                        "paginaInicial" => "1156"
                        "paginaFinal" => "1164"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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            2 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer&#58; Systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [ …4]
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                    0 => array:2 [
                      "doi" => "10.1136/thx.2008.109868"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax&#46;"
                        "fecha" => "2009"
                        "volumen" => "64"
                        "paginaInicial" => "757"
                        "paginaFinal" => "762"
                        "link" => array:1 [
                          0 => array:2 [ …2]
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              "identificador" => "bib0455"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer&#58; A systematic review and meta-analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [ …6]
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Diez años de ecobroncoscopia lineal: evidencia sobre su eficacia, seguridad y coste-efectividad
Ten Years of Linear Endobronchial Ultrasound: Evidence of Efficacy, Safety and Cost-effectiveness
Alberto Fernández-Villara,
Corresponding author
alberto.fernandez.villar@sergas.es

Autor para correspondencia.
, Cecilia Mouronte-Roibása, Maribel Botana-Riala, Alberto Ruano-Raviñab,c
a Servicio de Neumología de la EOXI Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Pontevedra, España
b Departamento de Medicina Preventiva, Facultad de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, España
c CIBER de Epidemiología y Salud Pública, CIBERESP, España
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          "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de referencias bibliogr&#225;ficas en Pubmed sobre EBUS desde el a&#241;o 2000 a 2014&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Desde su comercializaci&#243;n&#44; hace ya 10<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; la expansi&#243;n de la ecobroncoscopia lineal o sectorial con punci&#243;n en tiempo real &#40;<span class="elsevierStyleItalic">real-time EndobroBronchial UltraSound-guided TransBronchial Needle Aspiration</span> &#91;EBUS-TBNA&#93;&#41; para el diagn&#243;stico de enfermedades que cursan con afectaci&#243;n de ganglios hiliares y&#47;o mediast&#237;nicos y&#47;o lesiones peritraqueobronquiales ha sido probablemente el mayor hito en la historia de la broncoscopia tras la introducci&#243;n de la fibrobroncoscopia<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">1</span></a>&#46; Inicialmente dirigida al diagn&#243;stico y a la estadificaci&#243;n del c&#225;ncer de pulm&#243;n<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">2-4</span></a>&#44; pronto se demostr&#243; tambi&#233;n su utilidad en otras patolog&#237;as neopl&#225;sicas y granulomatosas que producen afectaci&#243;n mediast&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a>&#46; Adem&#225;s de evitar la realizaci&#243;n de pruebas m&#225;s invasivas&#44; ha supuesto una influencia positiva sobre los tiempos diagn&#243;sticos y una mejor relaci&#243;n coste-efectividad en el diagn&#243;stico y la estadificaci&#243;n del c&#225;ncer de pulm&#243;n<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">5-8</span></a>&#46; Hay tambi&#233;n evidencias sobre su posible papel en el drenaje de lesiones qu&#237;sticas mediast&#237;nicas o pleuroperic&#225;rdicas<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">9&#44;10</span></a>&#44; o para la valoraci&#243;n de patolog&#237;a vascular pulmonar<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El n&#250;mero de publicaciones que avalan la efectividad y la seguridad de esta t&#233;cnica se ha incrementado de forma exponencial &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Existen en el momento actual numerosos metaan&#225;lisis y revisiones sistem&#225;ticas&#44; estudios aleatorizados&#44; de cohortes&#44; de casos y controles&#44; series de casos y una ingente cantidad de revisiones narrativas que abordan diversos aspectos sobre la efectividad&#44; la eficiencia y la seguridad de esta t&#233;cnica&#46; En los &#250;ltimos 5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; muchos de los estudios asocian la efectividad de la EBUS-TBNA a la de la <span class="elsevierStyleItalic">transoEsophageal UltraSonography-guided Fine Needle Aspiration</span> &#40;EUS-FNA&#41; a trav&#233;s de la utilizaci&#243;n de 2 dispositivos diferentes&#44; o bien utilizando un solo dispositivo&#44; el ecobroncoscopio lineal&#44; para realizar el estudio de las lesiones accediendo tanto desde la v&#237;a a&#233;rea como desde el es&#243;fago &#40;EUS-B&#41;<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">12-15</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">En este contexto&#44; parece pues oportuno ordenar y resumir la evidencia cient&#237;fica sobre la efectividad y la eficiencia de los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os de pr&#225;ctica cl&#237;nica de la EBUS lineal&#44; especialmente en las indicaciones m&#225;s aceptadas<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para ello se ha realizado una exhaustiva y ordenada revisi&#243;n de todas las publicaciones incluidas en las bases de datos MEDLINE y EMBASE en relaci&#243;n con la EBUS lineal hasta abril de 2015&#44; present&#225;ndose fundamentalmente en forma de tablas&#46; Estas resumen las caracter&#237;sticas y los resultados de los metaan&#225;lisis y&#44; en su ausencia&#44; de todos los estudios controlados o de otro tipo que abordan espec&#237;ficamente una patolog&#237;a determinada&#46; En ellas se han incluido las variables que permiten al lector una evaluaci&#243;n global pero sencilla de la evidencia cient&#237;fica disponible sobre esta prueba diagn&#243;stica&#44; incluyendo la sensibilidad &#40;S&#41;&#44; la especificidad &#40;E&#41; y las razones de probabilidad positiva &#40;RPP&#41; y negativa &#40;RPN&#41;&#44; calculadas por los autores de esta revisi&#243;n en muchos casos&#44; ya que al no ser dependientes de la prevalencia permiten una mejor comparaci&#243;n entre los diferentes estudios que los valores predictivos<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; En los metaan&#225;lisis se ha incluido el &#237;ndice I<span class="elsevierStyleSup">2</span>&#44; que refleja el porcentaje total de variaci&#243;n de los resultados que se debe a la heterogeneidad de los estudios y no al azar&#44; de forma que cuanto m&#225;s se aproxime su valor al 100&#37;&#44; mayor ser&#225; la heterogeneidad de los trabajos incluidos<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">18</span></a>&#46; Finalmente&#44; se resume la evidencia actual en relaci&#243;n con la seguridad y el an&#225;lisis de coste-efectividad de esta t&#233;cnica&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">De forma deliberada&#44; en esta revisi&#243;n no se han incluido estudios dise&#241;ados para analizar aspectos t&#233;cnicos de la EBUS-TBNA o del procesado o valor de las muestras para estudios moleculares&#46; Sobre esto hay excelentes revisiones narrativas o documentos de consenso recientes<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">EBUS-TBNA en el diagn&#243;stico y estadificaci&#243;n del c&#225;ncer de pulm&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">La estadificaci&#243;n es una parte capital de la evaluaci&#243;n de todo paciente con c&#225;ncer de pulm&#243;n&#44; adquiriendo un papel crucial a la hora de identificar la invasi&#243;n maligna del mediastino en el c&#225;ncer de pulm&#243;n no microc&#237;tico &#40;CPNM&#41;&#46; En las gu&#237;as de pr&#225;ctica cl&#237;nica sobre diagn&#243;stico y estadificaci&#243;n mediast&#237;nica del c&#225;ncer de pulm&#243;n&#44; la EBUS-TBNA se considera una herramienta clave<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">21-23</span></a>&#44; avalada por multitud de trabajos&#46; La mayor&#237;a de ellos han sido incluidos en los 6 metaan&#225;lisis publicados hasta el momento<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">3&#44;4&#44;12&#44;13&#44;21&#44;24</span></a>&#44; de los que 3 consideran &#250;nicamente estudios sobre la EBUS-TBNA asociada al uso de la EUS<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">12&#44;13&#44;21</span></a>&#46; Las caracter&#237;sticas y los resultados de los mismos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; en la que se evidencia una elevada validez diagn&#243;stica del estudio endosonogr&#225;fico mediast&#237;nico en pacientes con c&#225;ncer de pulm&#243;n con un indudable valor en la toma de decisiones&#44; m&#225;xima en el caso de resultados positivos&#44; pero muy importante tambi&#233;n en los negativos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">En los 4 trabajos en los que se analiz&#243; este aspecto&#44; se detect&#243; una marcada heterogeneidad de los estudios incluidos&#44; debido a las diferencias en las pruebas de referencia utilizadas&#44; m&#233;todos de selecci&#243;n&#44; dise&#241;o de los estudios&#44; prevalencia de la enfermedad&#44; variabilidad en la t&#233;cnica y procedimiento&#44; experiencia o posibilidad de valoraci&#243;n in situ por pat&#243;logos de los centros participantes<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Aunque individualmente en los metaan&#225;lisis que analizan de forma conjunta el uso de EBUS-TBNA y EUS-FNA se demuestra una mayor S para la estrategia combinada frente a la EBUS-TBNA&#44; al comparar directamente la S que se obtiene en los distintos trabajos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41; esto no parece observarse&#44; lo que deja abierto el debate sobre si es necesaria la combinaci&#243;n de ambas t&#233;cnicas de forma sistem&#225;tica&#46; Alg&#250;n estudio espec&#237;fico muy reciente inclina la balanza hacia el estudio combinado&#44; empezando con la EBUS-TBNA como primer procedimiento<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La comparaci&#243;n directa de forma ciega entre la EBUS-TBNA y la mediastinoscopia&#44; realizadas ambas en todos los pacientes y en diferentes escenarios&#44; ha demostrado una eficacia diagn&#243;stica superior o al menos similar de la primera en los 3 estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0565"><span class="elsevierStyleSup">26-28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 1S&#44; Suplemento Online</a>&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">M&#225;s que la comparaci&#243;n entre las diferentes t&#233;cnicas&#44; las cuestiones clave en el momento actual parecen la elecci&#243;n de la adecuada secuencia de ellas y la necesidad de la confirmaci&#243;n de resultados negativos obtenidos por las t&#233;cnicas endosonogr&#225;ficas&#46; El estudio ASTER<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">14</span></a> fue el primer ensayo aleatorizado y multic&#233;ntrico que compar&#243; la estadificaci&#243;n mediast&#237;nica quir&#250;rgica con la ecoendosc&#243;pica completa&#44; seguida de la quir&#250;rgica si la primera era negativa&#44; en pacientes con CPNM con adenopat&#237;as mediast&#237;nicas de di&#225;metro superior a 10<span class="elsevierStyleHsp" style=""></span>mm en la TC o con PET positivo &#40;mediastino anormal por imagen&#41; y en casos de tumores centrales o sospecha de afectaci&#243;n N1 &#40;mediastino normal por imagen&#44; pero sospecha elevada de N2 oculto&#41;&#46; La S para el diagn&#243;stico de met&#225;stasis ganglionares fue del 79&#37; para la estadificaci&#243;n quir&#250;rgica y del 94&#37; para la ecoendosc&#243;pica&#44; seguida de la quir&#250;rgica si la primera era negativa&#46; Un an&#225;lisis posterior del estudio ASTER<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">29</span></a> aplicando metodolog&#237;a bayesiana demostr&#243; que la probabilidad posprueba de detecci&#243;n de adenopat&#237;as malignas no aumenta con el abordaje endosonogr&#225;fico seguido del quir&#250;rgico frente al primero exclusivamente cuando el mediastino es normal por imagen &#40;9&#37; en ambos casos&#41;&#44; pero s&#237; en los casos de mediastino anormal por imagen &#40;5&#37; vs&#46; 20&#37;&#41;&#44; lo que sugiere que solo deber&#237;an confirmarse quir&#250;rgicamente los resultados negativos en este caso&#46; Sin embargo&#44; estos datos no han sido reproducidos en el estudio ASTER<span class="elsevierStyleHsp" style=""></span>2&#44; que incluy&#243; pacientes con CPNM con sospecha cl&#237;nica de afectaci&#243;n ganglionar hiliar<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">30</span></a>&#44; lo que parece mantener abierto el debate de la necesidad de confirmaci&#243;n quir&#250;rgica de resultados negativos cuando la probabilidad preprueba es baja o moderada&#46; Diferentes estudios han demostrado que incluso con alteraciones en la TC o la PET la fiabilidad de los resultados negativos de la EBUS-TBNA var&#237;an mucho en funci&#243;n de una amplia serie de variables que dependen de caracter&#237;sticas de la neoplasia &#40;tipo&#44; localizaci&#243;n&#44; estadio&#44; tama&#241;o&#41;&#44; de las adenopat&#237;as &#40;localizaci&#243;n&#44; caracter&#237;sticas ecogr&#225;ficas&#44; tama&#241;o&#44; avidez en la PET&#41;&#44; del procedimiento &#40;n&#250;mero de pases&#44; cantidad y localizaci&#243;n de las estaciones muestreadas&#44; tipo de sedaci&#243;n&#41;&#44; de la experiencia de los endoscopistas y pat&#243;logos&#44; y de la calidad de la muestra obtenida<a class="elsevierStyleCrossRefs" href="#bib0590"><span class="elsevierStyleSup">31&#44;32</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las gu&#237;as de pr&#225;ctica cl&#237;nica m&#225;s recientes&#44; como la de la <span class="elsevierStyleItalic">American College of Chest Phisicians</span> &#40;ACCP&#41;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a>&#44; la de la Sociedad Espa&#241;ola de Patolog&#237;a Respiratoria &#40;SEPAR&#41;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">22</span></a> y la de la <span class="elsevierStyleItalic">European Society of Thoracic Surgeons</span> &#40;ESTS&#41;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">23</span></a>&#44; coinciden en incluir la EBUS-TBNA &#40;con&#47;sin EUS&#41; como primera t&#233;cnica para la confirmaci&#243;n de la afectaci&#243;n mediast&#237;nica del CPNM&#46; Sin embargo&#44; entre ellas existen aspectos poco definidos o incluso diferentes en la recomendaci&#243;n de la confirmaci&#243;n de los resultados negativos o en las indicaciones de estudio mediante EBUS-TBNA en pacientes con mediastino normal por imagen &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 2S Suplemento Online</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El valor de la EBUS-TBNA queda reforzado en un reciente estudio multic&#233;ntrico aleatorizado que demuestra que esta influye de forma favorable en los tiempos de diagn&#243;stico y estadificaci&#243;n y la supervivencia de los pacientes con CPNM<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">7</span></a>&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">EBUS-TBNA en la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n no microc&#237;tico tras tratamiento de inducci&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Hasta el momento se han publicado 5 estudios espec&#237;ficos con esta indicaci&#243;n y que incluyen en total a 363 pacientes con estadios histol&#243;gicos IIIA por N2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">33-37</span></a>&#46; Tres de ellos son estudios retrospectivos y de limitada casu&#237;stica&#44; con una marcada variabilidad en la prevalencia de afectaci&#243;n ganglionar mediast&#237;nica &#40;entre el 20 y el 88&#37;&#41; y el valor predictivo negativo de la EBUS-TBNA &#40;entre el 22 y el 94&#37;&#41;&#44; m&#225;s alto en los casos de menor incidencia de enfermedad N2 tras el tratamiento&#46; De forma general&#44; en comparaci&#243;n con su valor en la estadificaci&#243;n inicial del CPNM&#44; la EBUS-TBNA presenta en estos casos una S global m&#225;s baja&#44; una E y una RPP similares&#44; salvo en uno de los trabajos&#44; y una RPN que hace que la probabilidad posprueba pueda seguir siendo alta tras un resultado negativo&#46; Solo en el estudio de Szlubowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">37</span></a> se analiz&#243; la eficacia conjunta de la EBUS y el EUS&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">EBUS-TBNA en el diagn&#243;stico de masas intrapulmonares</span><p id="par0070" class="elsevierStylePara elsevierViewall">La EBUS-TBNA se ha utilizado frecuentemente para el diagn&#243;stico de pacientes con lesiones centrales&#44; paratraqueales o paraesof&#225;gicas no adenop&#225;ticas y sin afectaci&#243;n endobronquial&#44; muchas veces tras otros estudios broncosc&#243;picos negativos<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">38</span></a>&#46; Se han publicado 8 trabajos espec&#237;ficos&#44; casi todos series de casos retrospectivas&#44; que incluyen un total de 393 pacientes a los que se les realiz&#243; una EBUS-TBNA con esta indicaci&#243;n &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">39-46</span></a>&#46; De forma general&#44; la t&#233;cnica parece mostrar una alta S&#44; en la mayor&#237;a de los casos superior al 90&#37;&#46; La E &#250;nicamente se describe en 3 de ellos&#44; en los que es del 100&#37;&#44; resultando una RPN que reduce de forma considerable la probabilidad preprueba&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">EBUS-TBNA en el diagn&#243;stico de neoplasias extrator&#225;cicas</span><p id="par0075" class="elsevierStylePara elsevierViewall">Hasta un 30&#37; de tumores extrapulmonares pueden producir afectaci&#243;n de ganglios mediast&#237;nicos o hiliares&#46; En un metaan&#225;lisis reciente<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">47</span></a> del valor de la EBUS-TBNA con esta indicaci&#243;n&#44; en el que se incluyen 6 estudios &#40;533 pacientes&#41;&#44; la S agrupada fue del 85&#37;&#44; la E del 99&#37;&#44; la RPP de 28&#44;6 y la RPN de 0&#44;16&#46; Los tumores primarios m&#225;s frecuentes incluidos fueron&#58; cabeza y cuello&#44; colorrectal&#44; mama&#44; renal&#44; esof&#225;gico&#44; g&#225;strico&#44; prost&#225;tico y melanoma&#46; Dos estudios posteriores a este an&#225;lisis<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">48&#44;49</span></a> demostraron resultados similares&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">EBUS-TBNA en el diagn&#243;stico del linfoma</span><p id="par0080" class="elsevierStylePara elsevierViewall">El valor de la EBUS para estudiar la afectaci&#243;n mediast&#237;nica en procesos linfoproliferativos es la indicaci&#243;n de mayor controversia de las descritas en la presente revisi&#243;n&#44; dada la heterogeneidad de los estudios publicados<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">50</span></a>&#46; Se han publicado 7 trabajos espec&#237;ficos para el diagn&#243;stico de linfomas&#44; que incluyen 341 pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0690"><span class="elsevierStyleSup">51-57</span></a>&#46; El tama&#241;o muestral y la prevalencia son variables &#40;entre el 10 y el 66&#37;&#41; y los datos de validez y exactitud diagn&#243;stica que aportan son pobres en la mayor&#237;a&#44; con una S muy diferente entre los estudios&#44; aunque claramente mejor en los casos de recurrencias que en los linfomas primarios&#44; y una RPN que obligar&#237;a a confirmar los negativos&#46; En alguno de los trabajos&#44; el estudio mediante t&#233;cnicas de citometr&#237;a de flujo y la valoraci&#243;n inmediata por un pat&#243;logo o por comit&#233;s multidisciplinares podr&#237;an ayudar a mejorar la validez de la t&#233;cnica<a class="elsevierStyleCrossRefs" href="#bib0700"><span class="elsevierStyleSup">53&#44;55&#44;56</span></a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">EBUS-TBNA en el diagn&#243;stico de la sarcoidosis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Tras el c&#225;ncer de pulm&#243;n&#44; es en el estudio de la sarcoidosis donde m&#225;s evidencia existe sobre el papel de la EBUS-TBNA&#46; Disponemos de 2 metaan&#225;lisis recientes&#46; El primero&#44; de Agarwal et al&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">58</span></a>&#44; incluye a una poblaci&#243;n seleccionada con alta sospecha previa de sarcoidosis &#40;prevalencia<span class="elsevierStyleHsp" style=""></span>&#8776;<span class="elsevierStyleHsp" style=""></span>80&#37;&#41;&#44; mientras que el segundo&#44; realizado por Trisolini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">59</span></a>&#44; minimiza el sesgo de selecci&#243;n al analizar estudios que inclu&#237;an pacientes con sospecha por t&#233;cnicas de imagen de adenopat&#237;as patol&#243;gicas&#44; independientemente de la sospecha etiol&#243;gica subyacente &#40;prevalencia<span class="elsevierStyleHsp" style=""></span>&#8776;<span class="elsevierStyleHsp" style=""></span>15&#37;&#41;&#46; El primero re&#250;ne un total de 533 pacientes en 15 estudios&#44; mientras que el segundo incluye 2&#46;097 pacientes en 14 publicaciones&#44; con 3 estudios que se hallan incluidos en ambos&#46; La eficacia diagn&#243;stica fue del 79&#37; para ambos&#46; En el segundo metaan&#225;lisis la S diagn&#243;stica fue del 85&#37;&#44; con una RPN del 0&#44;16&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Existen tambi&#233;n un importante n&#250;mero de publicaciones en las que se compara la EBUS-TBNA &#40;con&#47;sin EUS-FNA&#41; con otras t&#233;cnicas convencionales para el estudio de sarcoidosis como la TBNA convencional &#40;TBNAc&#41; y la biopsia transbronquial &#40;BTB&#41;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">60</span></a>&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se resumen los datos de los 10 estudios disponibles hasta el momento&#44; la mayor&#237;a prospectivos o controlados&#44; que incluyen un total de 835 pacientes<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46; Aunque la EBUS-TBNA en la mayor&#237;a de ellos aporta una mayor rentabilidad diagn&#243;stica que la TBNAc o la BTB&#44; las diferencias son menores en los estadios<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">i</span> para la TBNAc&#44; sobre todo en adenopat&#237;as de tama&#241;o superior a 15<span class="elsevierStyleHsp" style=""></span>mm y en estaciones paratraqueales derechas o subcarinales&#44; y en los estadios<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleSmallCaps">ii</span> para la BTB<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46; La adici&#243;n sistem&#225;tica de la EUS-FNA y de las t&#233;cnicas convencionales potencia de forma importante su valor diagn&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">15&#44;61-69</span></a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">EBUS-TBNA en el diagn&#243;stico de tuberculosis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Se han publicado 6 estudios que de forma espec&#237;fica analizan el papel de la EBUS-TBNA para el diagn&#243;stico de tuberculosis que se presentan con adenopat&#237;as mediast&#237;nicas o hiliares &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">70-75</span></a>&#46; Estos trabajos&#44; que incluyen algo m&#225;s de 550 pacientes&#44; son en su mayor&#237;a series de casos de centros individuales&#44; salvo uno de ellos&#44; que es un estudio multic&#233;ntrico<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">71</span></a>&#46; La S y la RPN son muy variables &#40;con una E y una RPP similares&#41;&#44; y en varios de ellos mejoran de forma significativa al combinarse el estudio citol&#243;gico con el adecuado procesado microbiol&#243;gico convencional o por t&#233;cnicas moleculares<a class="elsevierStyleCrossRefs" href="#bib0805"><span class="elsevierStyleSup">74&#44;75</span></a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Coste-efectividad de la EBUS-TBNA</span><p id="par0100" class="elsevierStylePara elsevierViewall">Casi exclusivamente centrados en el c&#225;ncer de pulm&#243;n&#44; de forma general podr&#237;amos incluir 3 tipos de estudios&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los primeros estar&#237;an basados en la aplicaci&#243;n de modelos probabil&#237;sticos te&#243;ricos en funci&#243;n de los resultados previamente publicados encaminados a reducir los costes y a determinar la estrategia m&#225;s econ&#243;mica entre las alternativas disponibles &#40;t&#233;cnicas de imagen&#44; endosc&#243;picas o quir&#250;rgicas&#41;&#44; como el que se incluye en las gu&#237;as NICE de 2011 para el diagn&#243;stico y tratamiento del c&#225;ncer de pulm&#243;n<a class="elsevierStyleCrossRef" href="#bib0815"><span class="elsevierStyleSup">76</span></a>&#44; o el estudio de un grupo dan&#233;s<a class="elsevierStyleCrossRef" href="#bib0820"><span class="elsevierStyleSup">77</span></a>&#44; con resultados favorables en general hacia la estrategia que combina PET y EBUS-TBNA&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El segundo tipo de estudios ser&#237;an aquellos de coste-beneficio en los que&#44; bas&#225;ndose en la propia experiencia o en la publicada&#44; se realizan an&#225;lisis econ&#243;micos directos de minimizaci&#243;n de los costes de la aplicaci&#243;n de la EBUS-TBNA a cohortes reales o hipot&#233;ticas de pacientes con c&#225;ncer de pulm&#243;n frente a otras estrategias convencionales o quir&#250;rgicas de diagn&#243;stico y estadificaci&#243;n&#46; Existen al menos 7 estudios de 5 pa&#237;ses distintos en esta l&#237;nea<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">8&#44;78-83</span></a>&#44; resultando en 6 de ellos favorables a la EBUS-TBNA&#44; con una variaci&#243;n importante en los costes evitados en funci&#243;n del dise&#241;o del estudio y del sistema sanitario de cada pa&#237;s &#40;<a class="elsevierStyleCrossRef" href="#sec0070">tabla 3S Suplemento Online</a>&#41;&#46; En el &#250;nico en el que los costes de la mediastinoscopia fueron discretamente menores que los de la EBUS-TBNA&#44; esta se realizaba en quir&#243;fano y con anestesia general<a class="elsevierStyleCrossRef" href="#bib0850"><span class="elsevierStyleSup">83</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El &#250;ltimo grupo ser&#237;an estudios de coste-efectividad relacionados con la calidad de vida y la supervivencia&#44; como el que se realiz&#243; en la cohorte de pacientes incluida en el ASTER<a class="elsevierStyleCrossRef" href="#bib0855"><span class="elsevierStyleSup">84</span></a>&#44; realizado en el Reino Unido&#44; Holanda y B&#233;lgica&#46; Los resultados fueron favorables a la EBUS-TBNA&#44; que supone menores costes globales y mejor calidad de vida de los pacientes que las t&#233;cnicas quir&#250;rgicas&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Complicaciones de la EBUS-TBNA</span><p id="par0120" class="elsevierStylePara elsevierViewall">Debido a la importante expansi&#243;n de esta t&#233;cnica en la &#250;ltima d&#233;cada&#44; progresivamente se fueron comunicando de forma individual o agrup&#225;ndolos en peque&#241;as series de casos distintas complicaciones secundarias a la realizaci&#243;n de este procedimiento&#44; en la mayor parte de los casos escasas y de baja gravedad&#46; Hemos encontrado 3 trabajos que permiten extraer una informaci&#243;n global sobre la seguridad de esta t&#233;cnica&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La revisi&#243;n sistem&#225;tica de Von Bartheld et al&#46;<a class="elsevierStyleCrossRef" href="#bib0860"><span class="elsevierStyleSup">85</span></a>&#44; que incluy&#243; a un total de 9&#46;119 pacientes&#44; describe un 0&#44;14&#37; de complicaciones graves&#44; siendo las infecciosas y el neumot&#243;rax las m&#225;s prevalentes &#40;ambos del 0&#44;02&#37;&#41;&#44; de forma predominante en pacientes con lesiones qu&#237;sticas y sarcoidosis&#44; sin describir ning&#250;n fallecimiento&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Asano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0865"><span class="elsevierStyleSup">86</span></a>&#44; en una encuesta nacional llevada a cabo en Jap&#243;n sobre la realizaci&#243;n de la EBUS a 7&#46;345 pacientes&#44; refieren una prevalencia de complicaciones graves del 1&#44;23&#37;&#44; siendo la m&#225;s frecuente el sangrado &#40;0&#44;68&#37;&#41;&#44; seguido de las complicaciones infecciosas &#40;mediastinitis&#44; abscesos&#8230;&#41; en un 0&#44;17&#37;&#44; de insuficiencia respiratoria &#40;0&#44;07&#37;&#41;&#44; y por &#250;ltimo de neumot&#243;rax &#40;0&#44;03&#37;&#41;&#46; Se registr&#243; un fallecimiento&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; el registro prospectivo AQUIRE<a class="elsevierStyleCrossRef" href="#bib0870"><span class="elsevierStyleSup">87</span></a> en 6 hospitales de Estados Unidos encuentra en 1&#46;317 pacientes una incidencia de complicaciones graves del 1&#44;44&#37;&#44; siendo en su mayor&#237;a neumot&#243;rax &#40;0&#44;53&#37;&#41;&#44; seguido de insuficiencia respiratoria &#40;0&#44;23&#37;&#41; y de sangrado &#40;0&#44;2&#37;&#41;&#44; con un fallecimiento&#46; En este estudio se inclu&#237;an tambi&#233;n t&#233;cnicas convencionales&#44; como la BTB&#44; que fue un factor de riesgo independiente para el desarrollo de complicaciones&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclusiones</span><p id="par0140" class="elsevierStylePara elsevierViewall">En funci&#243;n de lo descrito en la presente revisi&#243;n&#44; parece que la EBUS-TBNA es una t&#233;cnica segura&#44; coste-efectiva y con una elevada validez diagn&#243;stica para el diagn&#243;stico y la estadificaci&#243;n mediast&#237;nica de pacientes con sospecha o confirmaci&#243;n de c&#225;ncer de pulm&#243;n&#44; con un grado de evidencia alto&#46; Sin embargo&#44; se precisa un mayor n&#250;mero de estudios que nos ayuden en la toma de decisiones ante un resultado negativo&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La evidencia disponible sobre el papel de la EBUS-TBNA en el diagn&#243;stico de sarcoidosis y neoplasias extrator&#225;cicas tambi&#233;n es elevada&#44; pero mucho menor cuando la t&#233;cnica se emplea para el estudio de tuberculosis&#44; de linfoma y para la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras quimioterapia neoadyuvante&#46; No obstante&#44; por su alta seguridad y menor invasividad que las t&#233;cnicas quir&#250;rgicas&#44; el grado de recomendaci&#243;n para emplear la EBUS-TBNA como la prueba diagn&#243;stica inicial en estas patolog&#237;as parece muy alto en la mayor&#237;a de los casos&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses en relaci&#243;n con los contenidos del presente manuscrito&#46;</p></span></span>"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de neoplasias extrator&#225;cicas"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico del linfoma"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de la sarcoidosis"
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          "titulo" => "EBUS-TBNA en el diagn&#243;stico de tuberculosis"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La <span class="elsevierStyleItalic">real-time EndobroBronchial UltraSound-guided TransBronchial Needle Aspiration</span> &#40;EBUS-TBNA&#41; ha supuesto uno de los principales hitos en la historia de la broncoscopia&#46; En los primeros 10<span class="elsevierStyleHsp" style=""></span>a&#241;os de utilizaci&#243;n se han publicado una ingente cantidad de art&#237;culos de todo tipo sobre el procedimiento y los resultados de esta t&#233;cnica que han avalado su utilizaci&#243;n en el estudio de diversas lesiones mediast&#237;nicas y pulmonares&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En el presente art&#237;culo se realiza una exhaustiva y ordenada revisi&#243;n de toda la evidencia cient&#237;fica disponible sobre sus indicaciones m&#225;s generalizadas&#44; mediante la descripci&#243;n de las caracter&#237;sticas y los resultados de los estudios espec&#237;ficos sobre su eficacia&#44; seguridad y coste-efectividad disponibles hasta el momento&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Este an&#225;lisis demuestra que la EBUS-TBNA es una t&#233;cnica segura&#44; coste-efectiva y con una elevada validez diagn&#243;stica para el diagn&#243;stico y la estadificaci&#243;n mediast&#237;nica de pacientes con sospecha o confirmaci&#243;n de c&#225;ncer de pulm&#243;n&#44; con un grado de evidencia alto&#46; Sin embargo&#44; se precisa de un mayor n&#250;mero de estudios que nos ayuden en la toma de decisiones ante un resultado negativo&#46; La evidencia disponible sobre el papel de la EBUS-TBNA en el diagn&#243;stico de sarcoidosis y neoplasias extrator&#225;cicas tambi&#233;n es elevada&#44; pero mucho menor cuando la t&#233;cnica se emplea para el estudio de tuberculosis y de linfoma y para la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras quimioterapia neoadyuvante&#46; No obstante&#44; por su alta seguridad y menor invasividad que las t&#233;cnicas quir&#250;rgicas&#44; el grado de recomendaci&#243;n para emplear la EBUS-TBNA como la prueba diagn&#243;stica inicial en estas patolog&#237;as parece muy alto en la mayor&#237;a de los casos&#46;</p></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Real-time endobronchial ultrasound-guided transbronchial needle aspiration &#40;EBUS-TBNA&#41; is one of the major landmarks in the history of bronchoscopy&#46; In the 10<span class="elsevierStyleHsp" style=""></span>years since it was introduced&#44; a vast body of literature on the procedure and its results support the use of this technique in the study of various mediastinal and pulmonary lesions&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This article is a comprehensive&#44; systematic review of all the available scientific evidence on the more general indications for this technique&#46; Results of specific studies on efficacy&#44; safety and cost-effectiveness available to date are examined&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The analysis shows that EBUS-TBNA is a safe&#44; cost-effective technique with a high grade of evidence that is a valuable tool in the diagnosis and mediastinal staging of patients with suspected or confirmed lung cancer&#46; However&#44; more studies are needed to guide decision-making in the case of a negative result&#46; Evidence on the role of EBUS-TBNA in the diagnosis of sarcoidosis and extrathoracic malignancies is also high&#44; but much lower when used in the study of tuberculosis&#44; lymphoma and for the re-staging of lung cancer after neoadjuvant chemotherapy&#46; Nevertheless&#44; due to its good safety record and lack of invasiveness compared to surgical techniques&#44; the grade of evidence for recommending EBUS-TBNA as the initial diagnostic test in patients with these diseases is very high in most cases&#46;</p></span>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0160" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material suplementario"
            "identificador" => "sec0070"
          ]
        ]
      ]
    ]
    "multimedia" => array:10 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1119
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            "Tamanyo" => 104595
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">N&#250;mero de referencias bibliogr&#225;ficas en Pubmed sobre EBUS desde el a&#241;o 2000 a 2014&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; I<span class="elsevierStyleSup">2</span>&#58; &#237;ndice I al cuadrado&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Estudios &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="middle" scope="col" style="border-bottom: 2px solid black">I<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Adams&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Gu&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">1&#46;299&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">74&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Dong&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">1&#46;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">0&#44;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">87&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Silvestri&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">2&#46;756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Silvestri&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">21</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">811&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Zhang&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">12</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">75&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Dhooria&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">13</span></a><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">1&#46;080&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="middle">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="middle">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981288.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Combinado con EUS-FNA&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los metaan&#225;lisis sobre el valor de la EBUS-TBNA en el diagn&#243;stico y estadificaci&#243;n del c&#225;ncer de pulm&#243;n</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ECA&#58; estudio controlado aleatorizado&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Herth&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Szlubowski&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zielinsky&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nasir&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Szlubowski&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981286.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en la reestadificaci&#243;n del c&#225;ncer de pulm&#243;n tras tratamiento de inducci&#243;n con quimioterapia</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nakajima&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tournoy&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhao&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lourido&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">42</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bhatti&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Verma&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bugalho&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">45</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dincer&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">46</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981289.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en el estudio pacientes con masas intrapulmonares</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; P&#58; linfoma primario&#59; R&#58; recurrencia de linfoma&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad &#40;incluye diagn&#243;stico y tipificaci&#243;n&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kennedy&#44; 2008<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Steinfort&#44; 2010<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Marshall&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iqbal&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 en P55 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ko&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moonim&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 en P100 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Talebian-Yazdi&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 en P88 en R&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981287.png"
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que analizan la validez diagn&#243;stica de la EBUS-TBNA en el estudio pacientes con linfoma</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BTB&#58; biopsia transbronquial&#59; ECA&#58; estudio controlado aleatorizado&#59; BNAc&#58; punci&#243;n transbronquial convencional&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidad</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TBNAc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BTB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">EBUS-TBNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oki&#44; 2007<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nakajima&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tremblay&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Navani&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plit&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Von Bartheld&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">304&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oki&#44; 2012<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gupta&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66-73&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Li&#44; 2014<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">68</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gnass&#44; 2015<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">69</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ECA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab981291.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Combinado con EUS-FNA&#44; sensibilidad del 80&#37; en el estudio de Von Bartheld et al&#46; y del 86&#37; en el de Gnass et al&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas y resultados de los estudios que comparan la validez diagn&#243;stica de la EBUS-TBNA con otras t&#233;cnicas broncosc&#243;picas convencionales en la sarcoidosis</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">E&#58; especificidad&#59; ND&#58; no disponible&#59; RPN&#58; raz&#243;n de probabilidad negativa&#59; RPP&#58; raz&#243;n de probabilidad positiva&#59; S&#58; sensibilidad&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Autor&#44; a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dise&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pacientes &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">E &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lin&#44; 2009<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">70</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Navani&#44; 2011<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">71</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sun&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0795"><span class="elsevierStyleSup">72</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ren&#44; 2013<a class="elsevierStyleCrossRef" href="#bib0800"><span class="elsevierStyleSup">73</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Retrospectivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8734;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;35&nbsp;\t\t\t\t\t\t\n
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ISSN: 03002896
Original language: Spanish
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