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Rebuttal From Drs Farjah and WoodRebuttal From Drs Farjah and Wood

Farhood Farjah, MD, MPH; Douglas E. Wood, MD, FCCP
Author and Funding Information

From the Department of Surgery/Division of Cardiothoracic Surgery, University of Washington.

Correspondence to: Farhood Farjah, MD, MPH, Department of Surgery/Division of Cardiothoracic Surgery, University of Washington, Box 356310, 1959 NE Pacific, AA-115, Seattle, WA 98195-6310; e-mail: ffarjah@uw.edu


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. See online for more details.


Chest. 2014;145(3):452-453. doi:10.1378/chest.13-2725
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Extract

We do not agree with Drs Wahidi and Ernst’s1 claims about the diagnostic yield and costs of endosonography, nor do we agree with the notion of invasiveness as a sole driver of clinical decision-making. To legitimately claim that a new diagnostic procedure is equivalent to a standard, one needs to conduct a noninferiority randomized trial.2 Such trials are designed to rule out clinically important differences between competing diagnostic or therapeutic interventions. Because a noninferiority trial comparing staging modalities has not been performed, one cannot claim that endosonography is as sensitive as mediastinoscopy. A more objective interpretation of the existing data reveals no evidence of inferiority or superiority of one diagnostic modality over the other. This interpretation, adopted by the National Comprehensive Cancer Network, has led to the recommendation that either mediastinoscopy or endosonography may be used for first-line invasive mediastinal staging.3

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