title: Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy.
abstract: OBJECTIVE
  There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative.
  
  
  RESULTS
  EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses.
  
  
  CONCLUSIONS
  Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.
authors.affiliation: Department of Respiratory Medicine, Allergy and Thoracic Surgery, Institute for Lung Health, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, Leicestershire, UK. andrew.medford@uhl-tr.nhs.uk
authors.forename: Andrew R L
authors.initials: AR
authors.lastname: Medford
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Bennett
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Free
authors.forename: Sanjay
authors.initials: S
authors.lastname: Agrawal
mesh_terms: D044963:Biopsy, Fine-Needle / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008481:Mediastinoscopy / Q000191:economics / Q000379:methods; D008482:Mediastinum / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D014463:Ultrasonography