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. 2022 Oct;14(10):3727-3736.
doi: 10.21037/jtd-22-183.

Perspective and practice patterns of mediastinal staging among thoracic surgeons

Ory Wiesel  1   2 , Daniel Kaufman  3 , Caralee Caplan-Shaw  4 , Jason Shaw  3
Affiliations

Perspective and practice patterns of mediastinal staging among thoracic surgeons

Ory Wiesel et al. J Thorac Dis. 2022 Oct.

Abstract

Background: Accurate mediastinal staging of lung cancer patients is critical for determining appropriate treatment. Mediastinoscopy and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration are the most commonly utilized techniques. Limited data exist on training and practice trends among thoracic surgeons. We aimed to determine training and practice patterns and find whether there is a paradigm shift in mediastinal staging after the introduction of EBUS into practice among thoracic surgeons in the United States.

Methods: 28-question survey was constructed querying demographic, training, and practice patterns with mediastinoscopy and EBUS and was sent to practicing thoracic surgeons in the United States. Descriptive statistics were used to summarize quantitative data.

Results: Ninety-eight responded with a 93% completion rate. Eighty-seven percent of respondents received training in EBUS and 70% perform EBUS routinely. All respondents believe EBUS should be incorporated into thoracic surgery training curriculums. Majority of those who prefer EBUS feel EBUS is safer than mediastinoscopy, allows access to lymph nodes stations or lesions inaccessible by mediastinoscopy and prefer EBUS to avoid re-do mediastinoscopy and in irradiated mediastinum. Majority of those who prefer mediastinoscopy reported they perform more accurate staging compared to EBUS, that mediastinoscopy is more accurate in diagnosing lymphoma or sarcoidosis and that frozen section can be done at the same interval as resection. Among surgeons who prefer EBUS, 94% biopsy 3 or more lymph node stations, 86% routinely biopsy hilar (N1) nodes while 8% never biopsy N1 nodes. Of surgeons who prefer mediastinoscopy. Ninety-seven percent biopsy 3 or more lymph node stations, only 27% routinely biopsy N1 nodes and 70% never biopsy N1 nodes.

Conclusions: EBUS is used frequently by thoracic surgeons in their practice for mediastinal staging. Methods of obtaining proficiency in EBUS widely varied among surgeons. In addition to mediastinoscopy, dedicated EBUS training should be incorporated into thoracic surgery training curriculums.

Keywords: Endobronchial ultrasound (EBUS); endoscopic training; mediastinal staging; mediastinoscopy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-183/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pre and post 2003 training comparisons (percentage). EBUS, endobronchial ultrasound.
Figure 2
Figure 2
Overall practice patterns (percentage). EBUS, endobronchial ultrasound.
Figure 3
Figure 3
Respondents answer to the question—“Do you agree that EBUS is safer than mediastinoscopy?”. MED, mediastinoscopy; EBUS, endobronchial ultrasound.
Figure 4
Figure 4
Respondents answers to the question—“When performing EBUS for lung cancer staging, how often do you biopsy N1 level nodes?”. EBUS, endobronchial ultrasound.
Figure 5
Figure 5
Respondents answer to the question—“When performing mediastinoscopy for lung cancer staging, how often do you biopsy N1 level nodes?”.
See this image and copyright information in PMC

Comment in

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