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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.

First, this is a diagnostic study, not a lung cancer–staging study because only 75 of 138 patients (54%) turned out to have lung cancer. Second, almost half of the evaluated patients (47%) presented with a mediastinal mass only without radiological evidence of a primary lung tumor.

Third, the . . . [Full Text of this Article]

Jouke T. Annema, MD, PhD
j.t.annema@lumc.nl
Leiden University Medical Center
Leiden, the Netherlands

Kurt G. Tournoy, MD, PhD
Ghent University Hospital
Ghent, Belgium

Klaus F. Rabe, MD, PhD
Leiden University Medical Center

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