Minimally invasive mediastinal staging of non-small cell lung cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure widely used for the diagnosis and staging of primary lung cancer. This review focuses on the role of EBUS-TBNA in minimally invasive mediastinal staging, restaging after induction therapy, and procedure-related issues. To better understand the role of EBUS-TBNA, one must consider issues of sedation and rapid onsite examination, sonographic features during the procedure, the number of aspirations per lymph node, and the thoroughness of the procedure. A literature review indicated that EBUS-TBNA showed equivalent or even superior performance to mediastinoscopy in the mediastinal staging of non-small cell lung cancer (NSCLC). Combining endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or the transesophageal approach using an EBUS bronchoscope (EUS-B-FNA) with EBUS-TBNA can provide additional diagnostic benefits. A recent guideline recommended endosonography over mediastinoscopy as the initial procedure for mediastinal nodal staging in patients with NSCLC with abnormal mediastinal and/or hilar lymph nodes on chest computed tomography (CT) or positron emission tomography/CT. The diagnostic sensitivity of EBUS-TBNA for restaging after induction therapy in patients with stage IIIA-N2 NSCLC was lower than that of initial staging. It appears reasonable to perform EBUS-TBNA first for initial mediastinal staging and reserve mediastinoscopy for restaging after induction therapy