Quality Gaps and Comparative Effectiveness in Lung Cancer Staging: The Impact of Test Sequencing on Outcomes

Guidelines for evaluation of patients with suspected lung cancer and evidence for mediastinal adenopathy in the absence of distant metastatic disease recommend mediastinal nodal sampling as the initial diagnostic/staging technique. In this study the authors evaluated compliance with that guideline in 137 pts. Guideline-compliant pts underwent 1.3 tests compared to 2.3 tests for guideline-noncompliant pts and experienced fewer complications (0% vs 17%). Most complications were related to unnecessary CT-FNA. Initial EBUS-TBNA was sufficient in 64%. Guideline compliance was only 22%.