title: Mediastinal staging of non-small-cell lung cancer among Australasian thoracic physicians: clinical practice and constraints on minimally invasive techniques.
abstract: OBJECTIVE
  We determined current practice among Australasian thoracic physicians in the mediastinal staging of non-small-cell lung cancer (NSCLC). We focused on the availability of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) and constraints to its use, as there has been no systematic analysis regarding the availability and uptake of this new technology among thoracic physicians.
  
  
  METHODS
  Physician members of the Thoracic Society of Australia and New Zealand were emailed a survey seeking their current approach to three scenarios requiring mediastinal staging of NSCLC. Respondents were also asked for their preferred investigation for each scenario if any current constraints were removed. Relevant demographic information was sought.
  
  
  RESULTS
  We received 164 responses from 512 Australasian physicians (34%). Without constraints, EBUS-TBNA was the preferred investigation for all three clinical scenarios, but only 33% of respondents had access to EBUS-TBNA. Constraints included lack of availability and lack of expertise. Reduced EBUS-TBNA access was associated with a number of clinician factors.
  
  
  CONCLUSIONS
  Australasian thoracic physicians prefer EBUS-TBNA for the mediastinal staging of NSCLC, but access to EBUS-TBNA services is limited. We recommend targeted measures to improve access to EBUS-TBNA use and optimise mediastinal staging of NSCLC.
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia. e.dabscheck@alfred.org.au
authors.forename: E J
authors.initials: EJ
authors.lastname: Dabscheck
authors.forename: D P
authors.initials: DP
authors.lastname: Steinfort
authors.forename: L B
authors.initials: LB
authors.lastname: Irving
authors.forename: M
authors.initials: M
authors.lastname: Hew
mesh_terms: D044362:Australasia; D044963:Biopsy, Fine-Needle / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D019160:Endosonography; D019538:Health Care Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008481:Mediastinoscopy; D008482:Mediastinum / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D010818:Practice Patterns, Physicians'; D013903:Thoracic Surgery; D013906:Thoracoscopy