© 2007 American Thoracic Society
Why Respiratory Physicians Should Learn and Implement EUS-FNATo the Editor:In their recent editorial, "EUS/EBUS—A New Dawn for the Respiratory Physician," Janes and Spiro raise the question whether it is "really a necessity" that gastroenterologists perform transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis and staging of lung cancer or that respiratory physicians should adopt this diagnostic method (1). We think this is indeed a relevant question. In our opinion, based on experience in investigating over 1,000 patients with lung cancer using EUS-FNA, we strongly favor the idea that EUS-FNA should be performed by respiratory physicians. The actual EUS-FNA investigation itself is just one aspect. Assessing the proper indication for EUS and weighing alternative diagnostic approaches—such as positron emission tomography (PET), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), and surgical staging—is essential. Major indications for EUS-FNA are diagnosing mediastinal or centrally located intrapulmonary lesions and mediastinal (re) staging. Nodes detected by EUS should be assigned and staged (N2/N3) according to the current lymph node map. EUS findings need to be related to further patient management to give referring physicians adequate feedback on EUS outcomes. Respiratory physicians are the experts on lung cancer staging, have the knowledge to interpret the various thoracic imaging modalities, and can best integrate all available clinical information. Obviously, gastroenterologists generally lack the specific knowledge just mentioned. Having said this just leaves the question whether respiratory physicians should enter the esophagus (cardiologists do) and implement this diagnostic method in their routine practice. Respiratory physicians are already accustomed to perform endoscopy. They should learn how to introduce a scope into the esophagus, interpret ultrasound images, and aspirate paraesophageal lesions. To address these questions, we conducted a prospective nationwide, government sponsored, implementation study (2005–2007) for EUS-FNA in lung cancer in The Netherlands (2). Based on current evidence in the literature (3), the question is no longer if but how EUS-FNA should be implemented for the care of patients with lung cancer. Now is the time for the pulmonary community to adopt EUS-FNA as a diagnostic method of our specialty. We should take up the challenge to develop standards, set up training centers, and facilitate implementation to ensure that patients with (suspected) lung cancer get access to promising minimally invasive diagnostic methodology.
Leiden University Medical Center, Leiden, The Netherlands FOOTNOTES Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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