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摘要

The possibility to sample the mediastinum does probably represent the most important progress associated with the practice of diagnostic bronchoscopy in the last 25 years. Transbronchial needle aspiration (TBNA) is a well-recognized, cheap and safe procedure, which has spared a huge number of patients the costs and risks of unnecessary diagnostic or therapeutic surgical procedures [1]. More recently, the swift development of health care technologies has provided the interventional pulmo-nologists with the opportunity to overcome the only great flaw of TBNA, i.e. its 'blindness'. Real-time endobron-chial ultrasound-guided TBNA (EBUS-TBNA), in fact, allows the examiner to localize with exquisite detail the mediastinal structures, and to sample the lymph nodes with great accuracy, while avoiding the great vessels [1]. There is a robust and growing body of literature demonstrating that EBUS-TBNA offers substantial diagnostic advantage over conventional TBNA, especially for small lymph nodes (<1.5 cm) and specific lymph node stations (e.g. 2 R-L and 4L) [2, 3]. These characteristics make EBUS-TBNA significantly better than conventional TBNA as a method for mediastinal staging of lung cancer in patients with a low prevalence of lymph node metasta-ses, which basically include most candidates for surgery [3-5]. Unfortunately, however, EBUS-TBNA is quite expensive in capital and running costs, and its availability is not yet widespread.