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Original Articles: General Thoracic

Invited Commentary

Division of Thoracic Surgery, Yale University, FMB 128, 330 Cedar St, New Haven, CT 06520-8062

(Email: frank.detterbeck{at}yale.edu).

In recent years there has been a flurry of articles extolling the utility of the new technology of endobronchial ultrasound (EBUS) that allows real-time guidance during transbronchial needle aspirations (TBNA) of mediastinal nodes. Interest in EBUS is fueled by the overwhelming momentum to adopt new technologies and because a large number of chest physicians never learned to be proficient at traditional "blind" TBNA. Together these factors have created the perception that anything less than EBUS is outmoded and not worthwhile.

The article published by Melloni and colleagues [1] offers an alternative view, suggesting that traditional blind TBNA is useful in staging of patients with lung cancer. This article demonstrates that not having all of the latest technology is not necessarily something to be embarrassed about; with appropriate skills and judgment, traditional methods are still quite useful. The primary limitation of TBNA was that a negative result mandated further invasive staging because of the risk of a false-negative result—a finding that is consistent with needle aspiration approaches in general.

Several factors are important to put this study in the appropriate context. TBNA was done by an experienced team that performed more than 100 such procedures each year. Patients were selected because they had nodes that were accessible to TBNA. Almost half of the nodes were subcarinal, a location that is considered most amenable to a blind TBNA. Furthermore, the nodes were large, with an average size of almost 2 cm. Finally, rapid on-site cytologic examination was used. These factors certainly contributed to the excellent results in this study. Some of these limitations can be overcome by the visual guidance afforded by EBUS, although the skill of the operator is still important. Perhaps more emphasis should be placed on attaining proficiency and on measures of quality in performing procedures than simply focusing technology alone.

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1. Melloni G, Casiraghi M, Bandiera A, et al. Transbronchial needle aspiration in lung cancer patients suitable for operation with positive mediastinal positron emission tomography Ann Thorac Surg 2009;87:373-378.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank Detterbeck Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Detterbeck, F. Search for Related Content PubMed PubMed Citation Articles by Detterbeck, F. Related Collections Lung - cancer Related Article