# Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial

Source: https://onco.cc/key-papers/paper-annema-jama/  
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## TL;DR

Paper cited by one technology page, indexed on Europe PMC as PubMed record 21098770 and published in JAMA; the citing page links this DOI, which is how the record was matched.

## Summary

Context: Mediastinal nodal staging is recommended for patients with resectable non-small cell lung cancer (NSCLC). Surgical staging has limitations, which results in the performance of unnecessary thoracotomies. Current guidelines acknowledge minimally invasive endosonography followed by surgical staging (if no nodal metastases are found by endosonography) as an alternative to immediate surgical staging.

Objective: To compare the 2 recommended lung cancer staging strategies.

Design, setting, and patients: Randomized controlled multicenter trial (Ghent, Leiden, Leuven, Papworth) conducted between February 2007 and April 2009 in 241 patients with resectable (suspected) NSCLC in whom mediastinal staging was indicated based on computed or positron emission tomography.

Intervention: Either surgical staging or endosonography (combined transesophageal and endobronchial ultrasound [EUS-FNA and EBUS-TBNA]) followed by surgical staging in case no nodal metastases were found at endosonography. Thoracotomy with lymph node dissection was performed when there was no evidence of mediastinal tumor spread.

Main outcome measures: The primary outcome was sensitivity for mediastinal nodal (N2/N3) metastases. The reference standard was surgical pathological staging. Secondary outcomes were rates of unnecessary thoracotomy and complications.

Results: Two hundred forty-one patients were randomized, 118 to surgical staging and 123 to endosonography, of whom 65 also underwent surgical staging. Nodal metastases were found in 41 patients (35%; 95% confidence interval [CI], 27%-44%) by surgical staging vs 56 patients (46%; 95% CI, 37%-54%) by endosonography (P =.11) and in 62 patients (50%; 95% CI, 42%-59%) by endosonography followed by surgical staging (P =.02). This corresponded to sensitivities of 79% (41/52; 95% CI, 66%-88%) vs 85% (56/66; 95% CI, 74%-92%) (P =.47) and 94% (62/66; 95% CI, 85%-98%) (P =.02). Thoracotomy was unnecessary in 21 patients (18%; 95% CI, 12%-26%) in the mediastinoscopy group vs 9 (7%; 95% CI, 4%-13%) in the endosonography group (P =.02). The complication rate was similar in both groups.

Conclusions: Among patients with (suspected) NSCLC, a staging strategy combining endosonography and surgical staging compared with surgical staging alone resulted in greater sensitivity for mediastinal nodal metastases and fewer unnecessary thoracotomies.

Trial registration: clinicaltrials.gov Identifier: NCT00432640.

Indexed on Europe PMC as PubMed record 21098770 (DOI 10.1001/jama.2010.1705). Matched by DOI alone: one technology page cites this DOI among its external links (the pages are listed under Related), and this page was written so that the citation resolves inside OnCo. No figure has been checked by an editor.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Tags: europepmc-ingest
- Journal: JAMA
- Year: 2010
- DOI: 10.1001/jama.2010.1705
- Authors: Annema JT, van Meerbeeck JP, Rintoul RC, et al.
- What it means: One technology page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
- Caveats: Matched to the citing OnCo records by DOI alone; the summary reproduces the Europe PMC abstract and no figure has been verified against the full paper.

## Sources

- JAMA 2010: https://doi.org/10.1001/jama.2010.1705
- PubMed: https://pubmed.ncbi.nlm.nih.gov/21098770/
- Europe PMC: https://europepmc.org/article/MED/21098770

## Connected records

- technologies: [Endoscopic ultrasound and EBUS systems](https://onco.cc/technologies/endoscopic-ultrasound-systems/)
- journals: [JAMA](https://onco.cc/journals/jama/)

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