Vardhman Mahavir Medical College & Safdarjung Hospital

Clinical guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as the initial diagnostic tool for lung cancer staging. However, despite the availability of mediastinal forceps biopsy and cryobiopsy, the optimal diagnostic approaches for other mediastinal conditions remain unclear.

We searched multiple databases and sources up to February 21, 2025, and employed single-arm, pairwise, and network meta-analytical approaches to comprehensively evaluate EBUS-based biopsies for mediastinal diseases in terms of efficacy and safety.

Fifteen prospective studies including 1,316 participants evaluated five EBUS-based mediastinal biopsy strategies (EBUS-TBNA, forceps biopsy, cryobiopsy, and the combinations of EBUS-TBNA with forceps biopsy or cryobiopsy) were involved. Concomitant EBUS-TBNA enhanced the efficacy of both forceps biopsy and cryobiopsy. EBUS-TBNA plus cryobiopsy yielded the best diagnostic outcome, showing significant benefits over EBUS-TBNA (OR 4.01, 95% CrI 3.05-5.33), forceps biopsy (OR 2.75, 95% CrI 1.94-3.92), cryobiopsy (OR 1.80, 95% CrI 1.33-2.45), and EBUS-TBNA plus forceps biopsy (OR 1.81, 95% CrI 1.20-2.72). A similarly favourable safety profile was observed in all EBUS-based biopsy methods.

EBUS-TBNA is the diagnostic cornerstone for mediastinal lesions, with EBUS-TBNA plus cryobiopsy being most effective. All EBUS-guided biopsies demonstrated a favourable safety profile.

Cervical cancer disproportionately affects women in LMICs, with treatment delays worsening outcomes. Despite WHO's 90-70-90 elimination goal, global disparities persist. This study systematically reviews worldwide delays from diagnosis to treatment, identifying contributing factors across income levels, healthcare systems, and treatment approaches.

We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Observational studies reporting the interval between histopathological diagnosis of cervical cancer and initiation of first-line definitive treatment (surgery, chemotherapy, radiotherapy, or combination therapy) were eligible. Search was performed in PubMed, Embase, Web of Science, and Scopus up to October 30, 2025. Two reviewers independently screened records, extracted data, and assessed study quality using the JBI Critical Appraisal Checklist. Pooled mean delays were estimated using random-effects models in STATA 19.5. Subgroup analyses and meta-regression explored heterogeneity by income level, data source, and treatment modality. Sensitivity analyses and publication bias assessments were performed using Galbraith plots, leave-one-out methods, Egger's test, and trim-and-fill procedures.

The pooled mean delay from diagnosis to treatment initiation was 71.42 days (95% CI: 47.96-94.88), exceeding recommended benchmarks of 30-60 days. Across studies, 59% of patients experienced treatment initiation delays exceeding 30 days, 54% exceeded 45 days, and 33% exceeded 90 days. Subgroup analysis revealed that high-income countries experienced shorter delays (40.50 days), while upper-middle-income countries faced significantly longer waits (94.63 days). Among treatment types, radiotherapy had the longest delay (79.90 days). The causes of delay were multifaceted, involving patient-level challenges such as stigma and financial constraints, systemic issues like inefficient referral processes and limited radiotherapy access, and disease-related factors. Despite substantial heterogeneity across studies (I² = 99.98%), sensitivity analyses validated the consistency and reliability of the pooled estimates.

This study provides the most comprehensive global estimate of cervical cancer treatment delays to date. The findings highlight critical disparities across income settings and healthcare systems, with actionable insights for policy and practice. Addressing these delays is essential to improving survival outcomes and achieving WHO's cervical cancer elimination targets. Strengthening referral systems, expanding radiotherapy infrastructure, and tailoring interventions to local barriers are key priorities.

Neurenteric cysts are rare, benign congenital lesions of endodermal origin that primarily affect the spinal cord. Their clinical and radiological presentations can vary significantly, especially in pediatric patients, complicating diagnosis and management. We report two pediatric cases of spinal neurenteric cysts and review the relevant literature. An 11-month-old infant presented with progressive lower limb weakness. Magnetic resonance imaging (MRI) revealed a nonenhancing intradural cystic lesion at the thoracic level. A 14-year-old female reported neck pain and upper limb paresthesia; cervical spine MRI showed a well-demarcated T2-hyperintense cystic lesion. Both patients underwent complete surgical excision. Histopathology confirmed neurenteric cysts, showing pseudostratified or columnar epithelium with interspersed goblet cells. Postoperative recovery was uneventful, with no recurrence at 6-month and 1-year follow-up, respectively. These cases underscore the variability in presentation and spinal level involvement of neurenteric cysts in children. MRI plays a central role in preoperative assessment, though definitive diagnosis relies on histopathology. Complete surgical excision remains the treatment of choice, offering favorable outcomes with low recurrence risk. The age extremes and differing anatomical locations in our cases reflect the broad clinical spectrum seen in pediatric patients. Spinal neurenteric cysts should be considered in children with unexplained spinal cord-related symptoms. Early imaging, accurate histological diagnosis, and total surgical excision are critical for optimal outcomes. Increased clinical awareness and case reporting will aid in improving recognition and management of this rare spinal lesion.