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Ann Thorac Surg 2011;91:1654. doi:10.1016/j.athoracsur.2011.01.071
© 2011 The Society of Thoracic Surgeons
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Correspondence

Reply

Robert Cerfolio, MD, FACS, Ayesha Bryant, MD, MSPH

Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294

(Email: abryant{at}uab.edu).

To the Editor:

We appreciate Dr Tedde's kind comments [1] in regard to our article [2]. He has described two other complementary techniques to endobronchial ultrasound imaging: video-assisted mediastinoscopic lymphadenectomy and transcervical extended mediastinoscopic lymphadenectomy. There is no doubt that video-assisted mediastinoscopy, which is easily learned by most general thoracic surgeons and which we use at The University of Alabama at Birmingham, adds improved visibility to standard mediastinoscopy and safety, in our opinion. In addition, it improves the teachability of mediastinoscopy for residents, fellows, and for the operating room staff. It also requires the surgeon who is doing mediastinoscopy to be more honest about which nodal stations are actually being biopsied and reported. However, the improved visibility and safety, although in our opinion an obvious advance, has not been proven through randomized trials to improve outcome or reduce morbidity.

Transcervical extended mediastinoscopic lymphadenectomy, however, is a different procedure. It is probably more dangerous during the learning curve and thus may require some limited specialized training to make it safe. The truth is that all of these lymph nodes staging procedures have their pluses and minuses, and each institution has to decide for itself which of these complementary tests are best. This decision is based on the equipment available, the training of the staff, and the different interests and level of expertise of the members of gastrointestinal medicine, pulmonary, and thoracic surgery. The importance of outstanding cytologists and pathologists cannot be understated. These are the factors the really determine which tests are done where and in which order as well as who is seeing the patient.

Finally, although the literature attempts to label the efficacy and accuracy of each one of these tests, this number is not translatable from one study to another. This is because efficacy depends first on the patients studied and the incidence of the disease in those sent for the test and second on the skill and experience of the endoscopists who perform the test.


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 References
 

  1. Tedde ML, Nabuco de Araujo PHX, Jatene FB. The true false-negative rates of EBUS and EUS (letter) Ann Thorac Surg 2011;91:1653-1654.[Free Full Text]
  2. Cerfolio RJ, Bryant AS, Eloubeidi MA, Frederick PA, Minnich DJ, Harbour KC, Dransfield MT. The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer Ann Thorac Surg 2010;90:427-434.[Abstract/Free Full Text]

Related Article

The True False-Negative Rates of EBUS and EUS
Miguel L. Tedde, Pedro Henrique X. Nabuco de Araujo, and Fabio Biscegli Jatene
Ann. Thorac. Surg. 2011 91: 1653-1654. [Extract] [Full Text] [PDF]




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Right arrow Lung - cancer
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