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Combined use of transoesophageal and transbronchial ultrasonography may lead to fewer unnecessary thoracotomies while staging NSCLC
  1. Samrat Bose
  1. Correspondence to Samrat Bose, ST3 Respiratory Medicine, Southampton General Hospital, Southampton, UK; samrat.resp{at}

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This study investigated the use of endosonography versus surgical staging in non-small cell lung cancer. Patients in the endosonography arm underwent transbronchial and transoesophageal ultrasonography to detect mediastinal involvement followed by surgical staging if no nodal involvement was found.

Two hundred and forty-one patients were randomised for surgical staging (118) or endosonography (123). Sixty-five patients in the endosonography group also underwent surgical staging. Nodal metastasis was found in 41 patients (35%) by surgical staging compared with 56 patients (46%) by endosonography alone and 62 patients (50%) by endosonography followed by surgical staging. Thoracotomy was unnecessary in 21 patients (18%) in the mediastinoscopy group compared with 9 patients (7%) in the endosonography group.

The use of combined endosonography and surgical staging resulted in an improvement in the detection of nodal metastasis and a reduction in unnecessary thoracotomies compared with surgical staging alone in patients with suspected non-small cell lung cancer. However, several nodes were out of reach of endosonography, and the technique is not available in all centres. Further research is needed, and the question remains as to whether all routinely negative endosonography patients should have mediastinoscopy or whether this approach is meant for a particular subgroup.

▶ Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010;304:2245–52.

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