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Reply to “Are We at the Dusk of Mediastinoscopy in Modern Clinical Practice?”

An Irresistible Trend
  • Hojoong Kim
    Correspondence
    Address for correspondence: Hojoong Kim, MD, PhD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul 135–710, Korea
    Affiliations
    Division of Pulmonary and, Critical Care Medicine, Department of Medicine, Samsung\Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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      In Response:
      At 2010, the lung cancer team of Samsung Medical Center agreed to begin the prospective study to directly compare the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with mediastinoscopy in nodal staging of non–small-cell lung cancer (NSCLC). We want to evaluate the accuracy of EBUS-TBNA and mediastinoscopy for nodal staging. The 2-year result of 138 consecutive patients was that EBUS-TBNA was superior to mediastinoscopy. Previous study to compare the EBUS-TBNA with mediastinoscopy showed no advantage to mediastinoscopy,
      • Ernst A
      • Anantham D
      • Eberhardt R
      • Krasnik M
      • Herth FJ
      Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy.
      and later prospective randomized trial showed that the accuracy of EBUS was similar to mediastinoscopy.
      • Yasufuku K
      • Pierre A
      • Darling G
      • et al.
      A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer.
      In addition, meta-analysis of 11 EBUS-TBNA studies reported the sensitivity of 93% and a specificity of 100%, which are superior to mediastinoscopy. There were meta-analysis papers for the complication rate, showing EBUS-TBNA of 0.05%,
      • von Bartheld MB
      • van Breda A
      • Annema JT
      Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review.
      compared with mediastinoscopy of 2%.
      • Toloza EM
      • Harpole L
      • Detterbeck F
      • McCrory DC
      Invasive staging of non-small cell lung cancer: a review of the current evidence.
      The cost-effectiveness of EBUS-TBNA was analyzed to be lower mean cost and greater mean quality-adjusted life years compared with mediastinoscopy.
      • Rintoul RC
      • Glover MJ
      • Jackson C
      • et al.
      Cost effectiveness of endosonography versus surgical staging in potentially resectable lung cancer: a health economics analysis of the ASTER trial from a European perspective.
      There are increasing training opportunities for EBUS-TBNA. World Association of Bronchology and Interventional Pulmonology has actively spreading the educational activities around the world and American College of Chest Physicians (ACCP) and local Bronchology Societies. American Thoracic Society, European Respiratory Society, and ACCP recommend that 40 supervised procedures for initial training and 20 procedures per year to maintain competency. As the training activity of EBUS-TBNA are increasing, training accessibility will be better and better. ACCP and European Society of Thoracic Surgeons guidelines recommend that EBUS-TBNA should be first applied for nodal staging of NSCLC.
      In conclusion, it is an irresistible trend that EBUS-TBNA is the first and the best procedure in the nodal staging of NSCLC.

      REFERENCES

        • Ernst A
        • Anantham D
        • Eberhardt R
        • Krasnik M
        • Herth FJ
        Diagnosis of mediastinal adenopathy-real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy.
        J Thorac Oncol. 2008; 3: 577-582
        • Yasufuku K
        • Pierre A
        • Darling G
        • et al.
        A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer.
        J Thorac Cardiovasc Surg. 2011; 142 (400.e1): 1393
        • von Bartheld MB
        • van Breda A
        • Annema JT
        Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review.
        Respiration. 2014; 87: 343-351
        • Toloza EM
        • Harpole L
        • Detterbeck F
        • McCrory DC
        Invasive staging of non-small cell lung cancer: a review of the current evidence.
        Chest. 2003; 123: 157S-166S
        • Rintoul RC
        • Glover MJ
        • Jackson C
        • et al.
        Cost effectiveness of endosonography versus surgical staging in potentially resectable lung cancer: a health economics analysis of the ASTER trial from a European perspective.
        Thorax. 2014; 69: 679-681

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