To the Editor: Dr Annema and colleagues1 conducted a methodical evaluation of mediastinal staging methods in non–small cell lung cancer (NSCLC). This trial showed that endosonographic staging with transesophageal ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) could obviate the need for mediastinoscopy in almost half the patients. These procedures are less invasive and have far less morbidity than mediastinoscopy. A combined approach, with mediastinoscopy reserved for those patients with negative findings from EUS-FNA and EBUS-TBNA, also resulted in superior sensitivity and negative predictive value over mediastinoscopy alone.
Pramesh CS, Jiwnani S, Karimundackal G. Mediastinal Staging Procedures in Non–Small Cell Lung Cancer. JAMA. 2011;305(9):890-891. doi:10.1001/jama.2011.224