PURPOSE: New minimally-invasive techniques such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are now available for mediastinal staging in non-small cell lung cancer (NSCLC). There has been little systematic analysis regarding availability and the uptake of this new technology among pulmonologists.
METHODS: A web-based survey was emailed to all Pulmonologists and Pulmonology Fellows on the Thoracic Society of Australia / New Zealand registry. We sought demographic information concerning their clinical practice and their level of training and experience in EBUS-TBNA. Respondents were asked to indicate their current staging approach to 3 clinical scenarios of NSCLC causing suspected malignant lymphadenopathy in different locations within the mediastinum (right hilum, right paratracheal and subcarina). We also surveyed their ideal staging investigation if there were no constraints to their choice.
RESULTS: 217 responses were received (42% response rate). Only a small minority of Australasian Pulmonogists have received training in EBUS-TBNA (19%). Furthermore, access to EBUS-TBNA is limited even at major tertiary centres. In all three clinical scenarios, a significant proportion of respondents chose surgical mediastinoscopy as their initial preferred investigation, but the vast majority (about 90%) of these indicated their choice was constrained by their lack of training in, or lack of availability of, minimally invasive techniques such as EBUS-TBNA.
CONCLUSION: This study demonstrates that overall uptake of EBUS-TBNA for the staging of mediastinal lymph nodes is low due to both a lack of training and a lack of access to the technique. It is likely that significant numbers of patients are undergoing surgical mediastinoscopy who would be suitable for less invasive staging.
CLINICAL IMPLICATIONS: Improved access and training in EBUS-TBNA would likely lead to increased utilization of less invasive techniques for mediastinal staging in NSCLC.
DISCLOSURE: Eli Dabscheck, No Financial Disclosure Information; No Product/Research Disclosure Information