PT  - JOURNAL ARTICLE
AU  - Hyo Jae Kang
AU  - Bin Hwangbo
AU  - Geon-Kook Lee
AU  - Byung-Ho Nam
AU  - Hyun-Sung Lee
AU  - Moon Soo Kim
AU  - Jong Mog Lee
AU  - Jae Ill Zo
AU  - Hee Seok Lee
AU  - Ji-Youn Han
TI  - EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial
AID  - 10.1136/thoraxjnl-2013-203881
DP  - 2014 Mar 01
TA  - Thorax
PG  - 261--268
VI  - 69
IP  - 3
4099  - http://thorax.bmj.com/content/69/3/261.short
4100  - http://thorax.bmj.com/content/69/3/261.full
SO  - Thorax2014 Mar 01; 69
AB  - Background The impact of procedure sequence and primary procedure has not been studied in the combined application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lung cancer staging. Methods In a randomised controlled trial, 160 patients with histologically confirmed or strongly suspected potentially operable non-small cell lung cancer were enrolled (Group A, n=80, EBUS-centred; Group B, n=80, EUS-centred). EBUS-TBNA and EUS-FNA with an ultrasound bronchoscope were used as the first procedures in Groups A and B, respectively, and secondary procedures (EUS-FNA in Group A, EBUS-TBNA in Group B) were added. Results Diagnostic values were evaluated in 148 patients (74 in each group). In Groups A and B the diagnostic accuracy (93.2% (95% CI 87.5% to 99.0%) vs 97.3% (95% CI 93.6% to 101.0%), p=0.245) and sensitivity (85.3% (95% CI 68.9% to 95.0%) vs 92.0% (95% CI 74.0% to 99.0%), p=0.431) in detecting mediastinal metastasis were not statistically different. In Group A, adding EUS-FNA to EBUS-TBNA did not significantly increase the accuracy (from 91.9% to 93.2%, p=0.754) or sensitivity (from 82.4% to 85.3%, p=0.742). In group B, adding EBUS-TBNA to EUS-FNA increased the accuracy (from 86.5% to 97.3%, p=0.016) and sensitivity (from 60.0% to 92.0%, p=0.008). There were no intergroup differences in procedure time, cardiorespiratory parameters during procedures, complications or patient satisfaction. Conclusions Using a combination of EBUS-TBNA and EUS-FNA in mediastinal staging, we found that diagnostic values and patient satisfaction were not different between the EBUS-centred and EUS-centred groups. However, the necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer. Trial Registration number ClinicalTrials.gov number NCT01385111.