CHEST Guidelines-Response_chest

Response_chest_19

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The correspondence discusses the role of endosonography in staging mediastinal nodal metastases in patients with operable lung cancer, specifically those suspected of having N1 involvement. Dr. Jouke T. Annema notes the significance of Dooms et al.'s study, published in CHEST, which highlights the lower sensitivity (38%) of endosonography for detecting N2 disease, despite a negative predictive value of 81%. Annema advocates that when using endobronchial ultrasound (EBUS), it should be complemented by endoscopic ultrasound (EUS) to increase detection sensitivity, particularly for nodes that are hard to access via EBUS alone. He notes that EUS-B can facilitate better sampling of small nodes in stations 4L and 7, areas otherwise difficult to assess using EBUS in sedated patients.<br /><br />In response, Dooms et al. express gratitude for Annema's insights, acknowledging the potential complementary role of EUS alongside EBUS. They clarify that while combined EBUS and EUS can be useful, especially for nodes inaccessible via EBUS, evidence is insufficient to claim EUS-B is consistently more effective. They emphasize that standardized mediastinal nodal mapping is now feasible with EBUS alone, which remains the standard approach in most centers, with EUS or EUS-B to be used as appropriate, particularly when EBUS sampling fails to represent lymphoid tissue. They conclude that staging cN1 lung cancer using endosonography, whether by EBUS or EBUS with EUS-B, faces challenges, with low sensitivity as a current limitation, and advocate for ongoing research to validate the consistent benefit of combining these approaches.

Keywords

endosonography

mediastinal nodal metastases

lung cancer

N1 involvement

endobronchial ultrasound

endoscopic ultrasound

sensitivity

staging

EUS-B

lymph node sampling