Utility of adding esophageal to endobronchial endosonography when staging lung cancer: A randomized trial

Introduction Both combined endobronchial ultrasonography (EBUS) and transesophageal bronchoscopic ultrasonography (EUS-B) and EBUS alone have been recommended for preoperative mediastinal staging of non-small cell lung cancer (NSCLC). However, no randomized study comparing these two methods has been published. The purpose of the present study was to compare the sensitivity of EBUS and that of combined EBUS and EUS-B (EBUS/EUS-B) in terms of detecting N2/N3 disease during staging of NSCLC.

Methods Patients with known or suspected, potentially operable NSCLC were recruited and randomized to undergo EBUS or EBUS/EUS-B under conscious sedation. The primary endpoint was a comparison of the sensitivity of EBUS alone and EBUS/EUS-B.

Results A total of 240 patients were enrolled and randomized, among whom 219 (105, EBUS group; 114, EBUS/EUS-B group) were included in analysis. The sensitivities of EBUS and EBUS/EUS-B in terms of detecting N2/N3 disease were 75.0 and 79.3% respectively (p=0.698). In the EBUS/EUS-B group, only EUS-B yielded diagnostic results in two patients; the sensitivity thus increased from 72.4 to 79.3% on addition of EUS-B to EBUS.

Conclusions The difference in the sensitivities of EBUS alone and EBUS/EUS-B in terms of diagnosing N2/N3 disease was not statistically significant. Although the increase in sensitivity with the addition of EUS-B is modest, it is maximized when EUS-B is used to sample lymph nodes not accessible by EBUS alone.