title: EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial.
abstract: BACKGROUND
  The impact of procedure sequence and primary procedure has not been studied in the combined application of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in lung cancer staging.
  
  
  METHODS
  In a randomised controlled trial, 160 patients with histologically confirmed or strongly suspected potentially operable non-small cell lung cancer were enrolled (Group A, n=80, EBUS-centred; Group B, n=80, EUS-centred). EBUS-TBNA and EUS-FNA with an ultrasound bronchoscope were used as the first procedures in Groups A and B, respectively, and secondary procedures (EUS-FNA in Group A, EBUS-TBNA in Group B) were added.
  
  
  RESULTS
  Diagnostic values were evaluated in 148 patients (74 in each group). In Groups A and B the diagnostic accuracy (93.2% (95% CI 87.5% to 99.0%) vs 97.3% (95% CI 93.6% to 101.0%), p=0.245) and sensitivity (85.3% (95% CI 68.9% to 95.0%) vs 92.0% (95% CI 74.0% to 99.0%), p=0.431) in detecting mediastinal metastasis were not statistically different. In Group A, adding EUS-FNA to EBUS-TBNA did not significantly increase the accuracy (from 91.9% to 93.2%, p=0.754) or sensitivity (from 82.4% to 85.3%, p=0.742). In group B, adding EBUS-TBNA to EUS-FNA increased the accuracy (from 86.5% to 97.3%, p=0.016) and sensitivity (from 60.0% to 92.0%, p=0.008). There were no intergroup differences in procedure time, cardiorespiratory parameters during procedures, complications or patient satisfaction.
  
  
  CONCLUSIONS
  Using a combination of EBUS-TBNA and EUS-FNA in mediastinal staging, we found that diagnostic values and patient satisfaction were not different between the EBUS-centred and EUS-centred groups. However, the necessity for EBUS-TBNA following EUS suggests that EBUS-TBNA is a better primary procedure in endoscopic mediastinal staging of potentially operable lung cancer.
  
  
  BACKGROUND
  ClinicalTrials.gov number NCT01385111.
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, , Goyang, Korea.
authors.forename: Hyo Jae
authors.initials: HJ
authors.lastname: Kang
authors.forename: Bin
authors.initials: B
authors.lastname: Hwangbo
authors.forename: Geon-Kook
authors.initials: GK
authors.lastname: Lee
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Nam
authors.forename: Hyun-Sung
authors.initials: HS
authors.lastname: Lee
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Kim
authors.forename: Jong Mog
authors.initials: JM
authors.lastname: Lee
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
authors.forename: Hee Seok
authors.initials: HS
authors.lastname: Lee
authors.forename: Ji-Youn
authors.initials: JY
authors.lastname: Han
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity