0
Correspondence |

Randomized Trials and BronchoscopyRandomized Trials and Bronchoscopy FREE TO VIEW

Michael K. Gould, MD, FCCP
Author and Funding Information

From the Department of Research and Evaluation, Kaiser Permanente Southern California.

Correspondence to: Michael K. Gould, MD, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101; e-mail: michael.k.gould@kp.org


Financial/nonfinancial disclosures: The author has 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. See online for more details.


Chest. 2013;143(2):584. doi:10.1378/chest.12-2423
Text Size: A A A
Published online
To the Editor:

I read with interest about the randomized clinical trial of endobronchial ultrasound with and without aspiration in the recent article by Casal et al1 in CHEST (September 2012). In this study, neither participants, nor bronchoscopists, nor pathologists were randomly assigned to comparison groups. Instead, the study was designed as a prospective comparison of two different bronchoscopic techniques, with each participant serving as his or her own control subject. Easy to miss, save for a single sentence in the “Materials and Methods” section, the unit of randomization was which procedure was performed first. Although this was a potentially rigorous design, the relevant details were not adequately captured by the “randomized clinical trial” designation, which was somewhat misleading.

In addition, the unit of randomization differed from the unit of analysis, which was the individual lymph node, with a total of 192 nodes sampled in 115 participants. Positive correlations between lymph nodes within individual participants introduce bias, leading to overly optimistic estimates of diagnostic accuracy and yield in both groups.2 Furthermore, the authors did not report the baseline characteristics of the participants according to group assignment, leaving the reader to wonder whether the randomization process resulted in groups that were reasonably well balanced.

As a member of the CHEST editorial board, I believe these issues should have been identified and clarified during the peer review and editorial process. The accompanying editorial would have been a good place to provide clarification, but this opportunity was missed.3

References

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Gould MK, Kuschner WG, Rydzak CE, et al. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139(11):879-892. [PubMed]
 
Angel L. The value of answering simple bronchoscopy questions with randomized clinical trials. Chest. 2012;142(3):551-552. [CrossRef] [PubMed]
 

Figures

Tables

References

Casal RF, Staerkel GA, Ost D, et al. Randomized clinical trial of endobronchial ultrasound needle biopsy with and without aspiration. Chest. 2012;142(3):568-573. [CrossRef] [PubMed]
 
Gould MK, Kuschner WG, Rydzak CE, et al. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139(11):879-892. [PubMed]
 
Angel L. The value of answering simple bronchoscopy questions with randomized clinical trials. Chest. 2012;142(3):551-552. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543