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Point/Counterpoint Editorials |

Point: Should UItrasonographic Endoscopy Be the Preferred Modality for Staging of Lung Cancer? YesEBUS for Staging Lung Cancer? Yes

Momen M. Wahidi, MD, MBA, FCCP; Armin Ernst, MD, MHCM, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Wahidi) and Department of Medicine, Duke University Medical Center; and Reliant Medical Group (Dr Ernst).

Correspondence to: Momen M. Wahidi, MD, MBA, FCCP, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Box 3683, Durham, NC 27710; e-mail: momen.wahidi@duke.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Wahidi has served as a consultant with Olympus Corp and received educational grants from Olympus Corp and Pentax of America Inc. Dr Ernst has reported 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. 2014;145(3):447-449. doi:10.1378/chest.13-2722
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Lung cancer remains the leading cause of cancer deaths in the United States, accounting for an estimated 29% and 26% of deaths in 2012 in men and women, respectively.1 Outcomes of patients with lung cancer vary dramatically on the basis of stage, with a 5-year survival ranging from 73% for stage IA to 13% for stage IV.2 Therefore, accurate staging of lung cancer plays an essential role in patient management, dictating the optimal treatment or combination of treatments with surgery, chemotherapy, or radiation therapy. Of particular interest for precise staging is the determination of metastatic involvement in mediastinal lymph nodes. Although radiographic imaging can be helpful, it suffers from low sensitivity (chest CT scan) or low specificity (PET scan).3 Tissue sampling remains the most accurate method to make this determination, following the cliché “tissue is the issue.” Mediastinoscopy has been the standard approach to mediastinal tissue biopsy for decades, but more recently, newer ultrasonographic endoscopic technology has emerged as a sensitive and less invasive mediastinal sampling approach. This technology includes endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) used separately or in combination. In this point editorial, we argue that EBUS- and EUS-guided transbronchial needle aspiration of the mediastinum should be the preferred first approach to mediastinal staging in lung cancer over cervical mediastinoscopy (CM) because of their high sensitivity, low morbidity, and reduced cost.

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