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To the Editor: In their study of minimally invasive endoscopic staging of suspected lung cancer, Dr Wallace and colleagues¹ concluded that endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) has higher sensitivity than traditional transbronchial needle aspiration (TBNA). When evaluating the relative accuracy of a newer technique, it is important to ensure that the standard technique (in this case TBNA) is performed to recognized standards.

The authors acknowledge that rapid on-site cytological evaluation (ROSE) may increase the yield of TBNA² but not of the ultrasound-guided techniques.³ The exclusion of ROSE from the study protocol may therefore have resulted in a suboptimized sensitivity of TBNA. Furthermore, the number of passes into the lymph node with traditional TBNA may also affect yield. The authors performed "at least 3" passes, while optimal yield may require 7 aspirates.² These 2 factors combined may have biased the study toward the ultrasound-guided techniques.

In addition, it is important to . . . [Full Text of this Article]

Neal Navani, MA, MRCP
Centre for Respiratory Research

Sam M. Janes, MSc, MRCP, PhD
Centre for Respiratory Research
University College London
London, United Kingdom

Stephen G. Spiro, MD, FRCP
stephen.spiro@uclh.nhs.uk
Department of Thoracic Medicine
University College Hospital
London, United Kingdom

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