CHEST Guidelines-Response_chest

Response_chest_13 (3)
Pdf Summary
The communication between Drs. Jouke T. Annema and Lars Konge emphasizes the necessity for the pulmonology community to integrate mediastinal endoscopic ultrasound (EUS), which has traditionally been performed by gastroenterologists, into their diagnostic processes. This includes incorporating endobronchial ultrasound (EBUS) training with EUS, especially for specific nodal stations, to enhance patient outcomes. They argue that pulmonologists, due to their familiarity with lung anatomy and related diagnostic procedures, are better suited to implement and manage EUS techniques, noting a pressing need for its widespread adoption.<br /><br />In response, Drs. Masahide Oki and Hideo Saka support this perspective, citing their study comparing EBUS-TBNA to EUS-guided fine-needle aspiration (EUS-FNA) using an EBUS scope for diagnosing mediastinal lesions. Their research indicates several procedural advantages with EUS-FNA, including better patient tolerance and less demanding procedural requirements, making it preferable, especially for patients with severe COPD. The correspondence further highlights the importance of training pulmonologists in EUS-FNA, ideally under expert guidance, to expand its implementation safely and effectively.<br /><br />The conversation underscores the necessity for a standard training protocol focusing on mediastinal anatomy as viewed through the esophagus and involving competency assessments. These discussions aim to raise awareness among pulmonologists regarding the clinical utility of EUS-FNA, anticipating improved outcomes in lung cancer staging and other mediastinal assessments.<br /><br />On a related note, the importance of nuanced lung ultrasonography in diagnosing conditions like pneumonia and cardiogenic pulmonary edema is echoed in another article, suggesting a need for a consensus and more precise diagnostic criteria in ultrasonographic applications to prevent misdiagnoses. Overall, the correspondence presents a clear call to action for structural changes and training in respiratory medicine to incorporate advanced ultrasonography techniques.
Keywords
pulmonology
mediastinal endoscopic ultrasound
EUS
endobronchial ultrasound
EBUS
training
EUS-FNA
lung cancer staging
ultrasonography
diagnostic procedures