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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 575-576

Authors' reply to Shah et al. and Keditsu


1 Department of OncoAnesthesiology, Malabar Cancer Centre, Thalassery, Kerala, India
2 Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India
3 Department of Surgical Oncology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India

Date of Submission21-Aug-2021
Date of Acceptance29-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Nizamudheen Mangalasseri Pareekutty
Department of Surgical Oncology, Malabar Cancer Centre, Thalassery - 670 103, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_199_21

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How to cite this article:
Chandveettil J, Pareekutty NM, Kattepur AK. Authors' reply to Shah et al. and Keditsu. Cancer Res Stat Treat 2021;4:575-6

How to cite this URL:
Chandveettil J, Pareekutty NM, Kattepur AK. Authors' reply to Shah et al. and Keditsu. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:575-6. Available from: https://www.crstonline.com/text.asp?2021/4/3/575/327786



We are grateful to Keditsu and Shah et al. for their valuable comments on our article published based on an online survey conducted on the trends of invasive mediastinal evaluation in India.[1],[2],[3] We also thank Dr. Krishnamurthy for the very informative editorial on the subject.[4]

As Keditsu[5] rightly pointed out, responses were obtained only from 20% of the invitees to the survey. This was despite multiple reminders and other forms of communication in some cases. The facility for training in invasive mediastinal evaluation, especially mediastinoscopy, is available only in a handful of centers in India, and only to a very limited number of students. As Keditsu suggested, another survey among the oncology practitioners in the private sector might improve our understanding of the gap between the requirement, availability, and expertise in that sector. Nevertheless, the survey was indicative of the importance of improving the level of training for invasive mediastinal evaluation across the country. Organizations such as the National Cancer Grid, Indian Association of Surgical Oncology, and Indian Society of Thoracic Surgeons are ideal platforms for short-term training programs in mediastinoscopy.

As Shah et al.[6] pointed out, our study has shown that the availability of endobronchial ultrasound (EBUS) and its role in mediastinal evaluation is increasing in India. Surprisingly, in our study, 10 participants reported an increase in the utilization of mediastinoscopy in their institutes over the preceding 2 years. If expertise is available, mediastinoscopy is much cheaper to install. The requirement of consumables for the procedure is also very low. The merits and drawbacks of EBUS and mediastinoscopy have been discussed by several authors.[5],[6],[7]

If EBUS-transbronchial needle aspiration (TBNA) is negative for carcinoma in the mediastinal nodes in lung cancer, mediastinoscopy is recommended to rule out nodal involvement, in view of the high false-positivity rate of EBUS. The requirement of two procedures and the additional cost associated with it is a source of concern and some institutions prefer mediastinoscopy over EBUS-TBNA when no targetable nodes are present in the mediastinum. The two procedures are considered complementary rather than competitive in modern oncological practice. Hence, training students in both procedures is of paramount importance.



 
  References Top

1.
Chandveettil J, Kattepur AK, Pareekutty NM, Kumbakara R, Balasubramanian S. Changing trends of invasive mediastinal evaluation in India: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:231-7.  Back to cited text no. 1
  [Full text]  
2.
Keditsu KK. Are we training enough? Cancer Res Stat Treat 2021;4:574-5.  Back to cited text no. 2
  [Full text]  
3.
Shah RS, Vaidya PJ, Chhajed PN. Endobronchial ultrasound-transbronchial needle aspiration (EBUSTBNA): It's prime time. Cancer Res Stat Treat 2021;4:572-3.  Back to cited text no. 3
  [Full text]  
4.
Krishnamurthy A. Bridging the gap between guidelines and practice for invasive mediastinal staging in nonsmallcell lung cancers. Cancer Res Stat Treat 2021;4:360-2.  Back to cited text no. 4
  [Full text]  
5.
Sehgal IS, Dhooria S, Aggarwal AN, Behera D, Agarwal R. Endosonography versus mediastinoscopy in mediastinal staging of lung cancer: Systematic review and meta-analysis. Ann Thorac Surg 2016;102:1747-55.  Back to cited text no. 5
    
6.
Shrager JB. Mediastinoscopy: still the gold standard. Ann Thorac Surg 2010;89:S2084-9.  Back to cited text no. 6
    
7.
Nalladaru ZM, Wessels A. The role of mediastinoscopy for diagnosis of isolated mediastinal lymphadenopathy. Indian J Surg 2011;73:284-6.  Back to cited text no. 7
    




 

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