To the Editor: Dr Wallace and colleagues1 concluded that the combination of EUS-FNA and EBUS-FNA achieved “near-complete” minimally invasive mediastinal staging in patients with suspected lung cancer. It was suggested that if EUS-FNA and EBUS-FNA were used to replace mediastinoscopy, 97% of patients would have been correctly labeled as negative. Although the concept of complete ultrasound-guided staging is both logical (both methods have a complementary diagnostic reach) and appealing (it is an ambulatory, minimally invasive strategy that is likely to be safe and cost-effective), there are a number of features of this study that require the data to be interpreted with caution.
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