Changing trends of invasive mediastinal evaluation in India: A questionnaire – based survey

Abstract

Background: The utilization of mediastinoscopy for mediastinal staging or evaluation has been on the wane, because of the increasing use of methods such as endoscopic ultrasound (EUS)/endobronchial ultrasound (EBUS). The choice of one modality over the other is based on individual preferences, expertise, cost, and the disease in question. Objectives: This study was aimed at assessing the changing trends in the practice of mediastinoscopy and endoscopic techniques across India. Materials and Methods: This online, questionnaire‑based survey was conducted at the Malabar Cancer Center, Kerala, India, between September 2019 and January 2020. Surgical oncologists, thoracic surgeons, and pulmonologists treating patients with lung cancer in the National Cancer Grid, India-affiliated institutions were enrolled. A total of 20 questions directed at determining the experience of the healthcare professionals, type of institutions where they practiced, the volume of patients with lung cancers being treated by them, and the temporal changes in the utility of mediastinoscopy and EBUS/EUS over the past 2 years were included in the questionnaire. The survey was conducted using Google Forms. Descriptive and inferential statistics were used for data analysis. A P < 0.05 was considered statistically significant. Results: A total of 347 clinicians were invited to participate in the survey, of which 70 responded. A total of 62 (88.6%) respondents recommended invasive mediastinal staging in patients with lung cancer with positive mediastinal nodes on positron emission tomography (PET). In addition, 39 (55.7%) respondents believed that invasive staging is required even in those with a negative mediastinum on PET; 58 (82.9%) respondents were of the opinion that EBUS is the investigation of choice for suspicious mediastinal nodes, while 8 (11.4%) preferred mediastinoscopy. Conclusion: Endoscopic techniques have superseded mediastinoscopy for invasive mediastinal evaluation across the country.