To the Editor: Dr Wallace and colleagues1 discussed the role of minimally invasive endoscopic diagnostic procedures in the work-up of enlarged and positron emission tomography (PET)–positive mediastinal lymph nodes in patients with suspected lung cancer. They compared 3 different endoscopic procedures (TBNA; endoscopic ultrasound-guided fine-needle aspiration, EUS-FNA; and EBUS-FNA) in 138 patients, reporting a high sensitivity (93%) and negative predictive value (97%) for the combination of EUS-FNA and EBUS-FNA. They concluded that these minimally invasive procedures may be a substitute for mediastinoscopy in selected cases. We would like to raise some concerns about this study.
Galetta D, Serra M, Spaggiari L. Lung Cancer Staging With Minimally Invasive Endoscopic Techniques. JAMA. 2008;299(21):2509-2511. doi:10.1001/jama.299.21.2509-b