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Editorials |

Endosonography for Lung Cancer Staging: One Scope Fits All?

Jouke T. Annema, MD, PhD; Klaus F. Rabe, MD, PhD
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From the Department of Pulmonology, Leiden University Medical Center.

Correspondence to: Jouke T. Annema, MD, PhD, Leiden University Medical Center, Department of Pulmonology C3-P, Albinusdreef 2, 2300 RC, Leiden, The Netherlands; e-mail: j.t.annema@lumc.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(4):765-767. doi:10.1378/chest.10-0955
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Lung cancer staging methodology has evolved dramatically over the past years, and transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in particular has emerged as a valuable diagnostic technique for mediastinal staging.1 Its particular strength lies in the detection of lymph nodes in the lower mediastinum and the aortopulmonary window while the pretracheal and hilar nodes are out of reach because of the interposition of air from the large airways. So far, EUS-FNA is performed with ultrasound endoscopes developed primarily for gastroenterologists. The required acquisition of this special equipment likely represents one of the barriers for the implementation of endoscopic ultrasound (EUS) in non-small cell lung cancer (NSCLC) staging in the pulmonary community. Mediastinal nodes also can be accurately sampled under ultrasound guidance from the airways (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA]).2 This technique is ideally suited to detect pretracheal and hilar nodes. Conceptually, combined EUS and endobronchial ultrasound (EBUS) investigation should enable virtually a complete evaluation of the mediastinum because of the complementary reach of different nodes for each technique. Accurate staging of NSCLC is critically important for assessing the extent of the tumor and planning optimal treatment. Both EUS-FNA and EBUS-TBNA are incorporated in recent lung cancer staging guidelines as a minimally invasive alternative for surgical staging to detect, but not exclude, nodal metastases.3,4 EUS-FNA added to mediastinoscopy5 or EBUS-TBNA6,7 improves preoperative staging of NSCLC and, therefore, reduces futile thoracotomies.

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