Bronchial endoscopic ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA) Zhang Ruixiang, Department of Thoracic Surgery, Henan Cancer Hospital and esophageal ultrasound-guided needle aspiration biopsy (EUS-FNA) have been widely used for mediastinal lymph node biopsy. Combined ultrasound-guided aspiration biopsy (CUS-NA), i.e. EBUS combined with EUS, for mediastinal staging of lung cancer has also been reported in a small number of cases, but there is no report on the application of mediastinal restaging after lung cancer induction therapy. In 2010, Herth, Bin et al. successively reported that EBUS and EUS were performed simultaneously using the same endoscope (CUSB-NA), which not only improved the diagnostic accuracy of mediastinal lymph node biopsy, but also, compared with CUS-NA, CUSB-NA could reduce the operation time and decrease the hospitalization cost. On the other hand, there is more debate on mediastinal restaging in patients with lung cancer after induction therapy, with the debate focusing on how to improve the diagnostic accuracy of the biopsy and which mediastinal staging diagnostic method to use. With this in mind, Dr. Szlubowski et al. from Poland conducted a study to evaluate the safety and accuracy of CUSB-NA for mediastinal restaging after induction therapy for lung cancer. The study included 106 patients with N2-positive (pathologically confirmed) non-small cell carcinoma treated with induction chemotherapy who underwent CUSB-NA mediastinal lymph node biopsy, with a total of 286 stations of lymph nodes biopsied (mean 2.7 stations/person, range 2-5 stations/person), of which 127 stations were biopsied with EBUS-TBNA (mean 1.2 stations/person, range 1-3 stations/person) and 159 stations with EUS-FNA ( average 1.5 stations/person, range 1-4 stations/person). In addition, CUSB-NA confirmed positive mediastinal lymph nodes in 37 patients (34.9%), of which 2 (1.9%) were determined to be false positive by further transcervical expanded mediastinal lymph node dissection (TEMLA). 69 patients with negative or undiagnosed mediastinal lymph nodes diagnosed by CUSB-NA were determined to have positive mediastinal lymph nodes in 18 patients (17.0%) by further (TEMLA). Lymph nodes were positive, of which 10 (9.4%) patients had single-station lymph node positivity, 9 patients with false negatives were 2R, 4R group lymph nodes (biopsy from EBUS only) had false negatives, and 4 patients had positive group 5 lymph nodes (not biopsiable by CUSB-NA). Using TEMLA as the gold standard for diagnosis, this study found a positive mediastinal lymph node rate of 51.9% after N2 positive induction chemotherapy, a sensitivity rate of 67.3%, specificity of 96.0%, accuracy of 81.0%, positive predictive value of 95.0%, and negative predictive value of 73.0% for CUSB-NA for the diagnosis of mediastinal lymph nodes, compared with EBUS-TBNA only or The sensitivity, accuracy, and negative predictive value of CUSB-NA were higher compared with EBUS-TBNA or EUS-FNA only. There were no complications associated with CUSB-NA biopsy in all patients. Based on these findings, Dr. Szlubowski et al. concluded that CUSB-NA is safe and effective for mediastinal restaging in patients with lung cancer after induction therapy, and that further mediastinal staging is recommended for patients with negative mediastinal lymph nodes diagnosed by CUSB-NA, given its diagnostic sensitivity.