Ultrasound-Guided Transbronchial and Transesophageal Needle Biopsy in the Mediastinal Staging of Lung Cancer

Relevance of endoscopic ultrasonography and endobronchial ultrasonography to thoracic surgeons

Although cervical mediastinoscopy has been considered the gold standard for mediastinal staging in non-small cell lung cancer, new minimally invasive endoscopic ultrasound technology, such as endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound fine-needle aspiration, have changed the practice of invasive staging. Based on the current evidence, minimally invasive endoscopic staging is the recommended choice in patients with high pretest probability of lymph node metastasis; however, all negative results should be verified by mediastinoscopy, especially in centers with low expertise. In patients with low pretest probability, mediastinoscopy may be omitted when adequate sampling is achieved with endoscopic modalities.