To the Editor: Dr Wallace and colleagues1 concluded that the combination of EUS-FNA and EBUS-FNA achieved “near-complete” minimally invasive mediastinal staging in patients with suspected lung cancer. It was suggested that if EUS-FNA and EBUS-FNA were used to replace mediastinoscopy, 97% of patients would have been correctly labeled as negative. Although the concept of complete ultrasound-guided staging is both logical (both methods have a complementary diagnostic reach) and appealing (it is an ambulatory, minimally invasive strategy that is likely to be safe and cost-effective), there are a number of features of this study that require the data to be interpreted with caution.
Annema JT, Tournoy KG, Rabe KF. Lung Cancer Staging With Minimally Invasive Endoscopic Techniques. JAMA. 2008;299(21):2509-2511. doi:10.1001/jama.299.21.2510-a