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To the Editor: Dr Wallace and colleagues¹ discussed the role of minimally invasive endoscopic diagnostic procedures in the work-up of enlarged and positron emission tomography (PET)–positive mediastinal lymph nodes in patients with suspected lung cancer. They compared 3 different endoscopic procedures (TBNA; endoscopic ultrasound-guided fine-needle aspiration, EUS-FNA; and EBUS-FNA) in 138 patients, reporting a high sensitivity (93%) and negative predictive value (97%) for the combination of EUS-FNA and EBUS-FNA. They concluded that these minimally invasive procedures may be a substitute for mediastinoscopy in selected cases. We would like to raise some concerns about this study.

First, according to the recent American College of Chest Physicians recommendations,² "for patients with discrete mediastinal lymph node enlargement (and no distant metastases), a nonmalignant result from a needle technique [EUS-FNA, TBNA, EBUS-FNA] should be further confirmed by mediastinoscopy (regardless of whether a PET finding is positive or negative in the mediastinal nodes)." In the . . . [Full Text of this Article]

Domenico Galetta, MD
mimgaletta@yahoo.com
Division of Thoracic Surgery
European Institute of Oncology
Milan, Italy

Maria Serra, MD
SOC Pneumologia
Ospedale Cardinal Massaia
Asti, Italy

Lorenzo Spaggiari, MD, PhD
European Institute of Oncology
Milan, Italy

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