Quality Gaps and Comparative Effectiveness in Lung Cancer Staging: The Impact of Test Sequencing on Outcomes [1]
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%.