ERS/ESGE/ESTS clinical practice guidelines on endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer
Three societies, twelve questions and a straightforward answer to the oldest of them: in suspected non-small-cell lung cancer, endosonography rather than mediastinoscopy is the way to stage the mediastinum, and a negative endosonography does not need mediastinoscopy after it. Systematic sampling is the minimal standard rather than targeted sampling, the combined endobronchial and oesophageal approach is preferred over endobronchial alone, and the same applies to restaging after induction therapy. On the instruments the document is deliberately conservative: 21G and 22G aspiration needles are the standard, and there is not enough evidence to recommend other needle sizes, other needle types or cryobiopsy. Competence should be built in a simulator and confirmed with a validated assessment. The literature search closed in April 2025, so the trials below were presented after it, at the congress where the guideline was itself presented.
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Published since the guideline2
- 2026COFIDENCEOnco · Poumon · Diagnosis & stagingComparison of diagnostic yield and safety of three endobronchial ultrasound-guided transbronchial biopsy techniques in diagnosing patients with mediastinal/hilar lymphadenopathy (COFIDENCE Study)
- 2026ARTICULAtEOnco · Poumon · Diagnosis & stagingA Randomized Controlled Trial to Compare Robotic Assisted Bronchoscopy Ion's Clinical Utility for Peripheral Lung Nodule Access and Diagnosis to ENB (ARTICULAtE)