{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T16:54:54Z","timestamp":1793379294094,"version":"4.5.0"},"reference-count":39,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100010477","name":"Intuitive Surgical Inc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010477","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","journal.chestnet.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Chest"],"published-print":{"date-parts":[[2021,12]]},"DOI":"10.1016\/j.chest.2021.06.065","type":"journal-article","created":{"date-parts":[[2021,7,10]],"date-time":"2021-07-10T10:34:46Z","timestamp":1625913286000},"page":"2304-2323","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":22,"title":["Optimizing Diagnostic and Staging Pathways for Suspected Lung Cancer"],"prefix":"10.1016","volume":"160","author":[{"given":"Erik","family":"Vakil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nsikak","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula V.","family":"Sainz-Zu\u00f1ega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Molina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Martinez-Zayas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott B.","family":"Cantor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horiana B.","family":"Grosu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto F.","family":"Casal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Ost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"suppl 5","key":"10.1016\/j.chest.2021.06.065_bib1","doi-asserted-by":"crossref","first-page":"e142S","DOI":"10.1378\/chest.12-2353","article-title":"Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"143","author":"Rivera","year":"2013","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib3","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1378\/chest.12-3046","article-title":"Quality gaps and comparative effectiveness in lung cancer staging: the impact of test sequencing on outcomes","volume":"144","author":"Almeida","year":"2013","journal-title":"Chest"},{"issue":"5","key":"10.1016\/j.chest.2021.06.065_bib4","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.chest.2019.09.025","article-title":"Quality gaps and comparative effectiveness in lung cancer staging and diagnosis","volume":"157","author":"Ost","year":"2020","journal-title":"Chest"},{"issue":"26","key":"10.1016\/j.chest.2021.06.065_bib5","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1056\/NEJMp1011024","article-title":"What is value in health care?","volume":"363","author":"Porter","year":"2010","journal-title":"N\u00a0Engl J Med"},{"issue":"suppl 5","key":"10.1016\/j.chest.2021.06.065_bib6","doi-asserted-by":"crossref","first-page":"e211S","DOI":"10.1378\/chest.12-2355","article-title":"Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"143","author":"Silvestri","year":"2013","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib7","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1378\/chest.12-0350","article-title":"Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry","volume":"143","author":"Eapen","year":"2013","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib8","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.chest.2017.11.004","article-title":"Impact of rapid on-site cytological evaluation (ROSE) on the diagnostic yield of transbronchial needle aspiration during mediastinal lymph node sampling: systematic review and meta-analysis","volume":"153","author":"Sehgal","year":"2018","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2021.06.065_bib9","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1183\/09031936.00044612","article-title":"Radial probe EBUS versus CT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis","volume":"41","author":"Steinfort","year":"2013","journal-title":"Eur Respir J"},{"issue":"8","key":"10.1016\/j.chest.2021.06.065_bib10","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1001\/archinte.1997.00440290031002","article-title":"The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules","volume":"157","author":"Swensen","year":"1997","journal-title":"Arch Intern Med"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib11","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1378\/chest.10-2914","article-title":"Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry","volume":"140","author":"Ost","year":"2011","journal-title":"Chest"},{"issue":"1","key":"10.1016\/j.chest.2021.06.065_bib12","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1164\/rccm.201507-1332OC","article-title":"Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry","volume":"193","author":"Ost","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"issue":"12","key":"10.1016\/j.chest.2021.06.065_bib13","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1164\/rccm.201607-1397OC","article-title":"A\u00a0prediction model to help with the assessment of adenopathy in lung cancer: HAL","volume":"195","author":"O'Connell","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"issue":"2","key":"10.1016\/j.chest.2021.06.065_bib14","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1164\/rccm.201904-0831OC","article-title":"A\u00a0prediction model to help with oncologic mediastinal evaluation for radiation: HOMER","volume":"201","author":"Martinez-Zayas","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib15","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.chest.2019.10.042","article-title":"Sensitivity of radial endobronchial ultrasound-guided bronchoscopy for lung cancer in patients with peripheral pulmonary lesions: an updated meta-analysis","volume":"157","author":"Sainz Zuniga","year":"2020","journal-title":"Chest"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib16","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1183\/09031936.00075310","article-title":"Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis","volume":"37","author":"Steinfort","year":"2011","journal-title":"Eur Respir J"},{"issue":"5","key":"10.1016\/j.chest.2021.06.065_bib17","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/j.chest.2018.08.1026","article-title":"Standard bronchoscopy with fluoroscopy vs\u00a0thin bronchoscopy and radial endobronchial ultrasound for biopsy of pulmonary lesions: a multicenter, prospective, randomized trial","volume":"154","author":"Tanner","year":"2018","journal-title":"Chest"},{"issue":"11","key":"10.1016\/j.chest.2021.06.065_bib18","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/crj.13077","article-title":"Pleural dye marking of lung nodules by electromagnetic navigation bronchoscopy","volume":"13","author":"Bowling","year":"2019","journal-title":"Clin Respir J"},{"key":"10.1016\/j.chest.2021.06.065_bib19","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.lungcan.2019.01.006","article-title":"Diagnosing a solitary pulmonary nodule using multiple bronchoscopic guided technologies: a prospective randomized study","volume":"129","author":"Bo","year":"2019","journal-title":"Lung Cancer"},{"issue":"9","key":"10.1016\/j.chest.2021.06.065_bib20","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1097\/JTO.0000000000000249","article-title":"Can computed tomography characteristics predict outcomes in patients undergoing radial endobronchial ultrasound-guided biopsy of peripheral lung lesions?","volume":"9","author":"Evison","year":"2014","journal-title":"J\u00a0Thoracic Oncol"},{"issue":"8","key":"10.1016\/j.chest.2021.06.065_bib21","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/j.1445-5994.2011.02707.x","article-title":"Prospective randomised trial of endobronchial ultrasound-guide sheath versus computed tomography-guided percutaneous core biopsies for peripheral lung lesions","volume":"42","author":"Fielding","year":"2012","journal-title":"Intern Med J"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib22","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.chest.2020.05.534","article-title":"sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: systematic review and meta-analysis","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"issue":"3","key":"10.1016\/j.chest.2021.06.065_bib23","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000226128","article-title":"Accuracy and feasibility of electromagnetic navigated bronchoscopy under nitrous oxide sedation for pulmonary peripheral opacities: an outpatient study","volume":"78","author":"Bertoletti","year":"2009","journal-title":"Respiration"},{"issue":"3","key":"10.1016\/j.chest.2021.06.065_bib24","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.athoracsur.2011.11.006","article-title":"Electromagnetic navigation bronchoscopy performed by thoracic surgeons: one center's early success","volume":"93","author":"Pearlstein","year":"2012","journal-title":"Ann Thorac Surg"},{"issue":"12","key":"10.1016\/j.chest.2021.06.065_bib25","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1002\/dc.23164","article-title":"Electromagnetic navigation bronchoscopy-guided fine needle aspiration for the diagnosis of lung lesions","volume":"42","author":"Odronic","year":"2014","journal-title":"Diagn Cytopathol"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib26","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1378\/chest.09-2708","article-title":"Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a bronchus sign on CT imaging: results from a prospective study","volume":"138","author":"Seijo","year":"2010","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib27","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1183\/09031936.00165306","article-title":"Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions","volume":"29","author":"Makris","year":"2007","journal-title":"Eur Respir J"},{"issue":"2","key":"10.1016\/j.chest.2021.06.065_bib28","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/LBR.0b013e31824dd9a1","article-title":"Electromagnetic navigational bronchoscopy in the diagnosis of lung lesions","volume":"19","author":"Brownback","year":"2012","journal-title":"J\u00a0Bronchology Interv Pulmonol"},{"issue":"7","key":"10.1016\/j.chest.2021.06.065_bib29","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1513\/AnnalsATS.201711-863OC","article-title":"Endobronchial ultrasound for nodal staging of patients with non-small-cell lung cancer with radiologically normal mediastinum. A meta-analysis","volume":"15","author":"El-Osta","year":"2018","journal-title":"Ann Am Thorac Soc"},{"issue":"suppl 1","key":"10.1016\/j.chest.2021.06.065_bib30","doi-asserted-by":"crossref","first-page":"115S","DOI":"10.1378\/chest.123.1_suppl.115S","article-title":"Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence","volume":"123","author":"Schreiber","year":"2003","journal-title":"Chest"},{"issue":"5","key":"10.1016\/j.chest.2021.06.065_bib31","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/cyt.12328","article-title":"Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre","volume":"27","author":"Thiryayi","year":"2016","journal-title":"Cytopathology"},{"issue":"2","key":"10.1016\/j.chest.2021.06.065_bib32","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.canlet.2015.11.038","article-title":"Rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for the diagnosis of hilar and mediastinal lymphadenopathy in patients with lung cancer","volume":"371","author":"Guo","year":"2016","journal-title":"Cancer Lett"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib33","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1159\/000346987","article-title":"Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study","volume":"85","author":"Oki","year":"2013","journal-title":"Respiration"},{"issue":"5","key":"10.1016\/j.chest.2021.06.065_bib34","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/j.athoracsur.2012.09.074","article-title":"Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer","volume":"95","author":"Nakajima","year":"2013","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"10.1016\/j.chest.2021.06.065_bib35","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1089\/tmj.2012.0168","article-title":"Feasibility of dynamic telecytopathology for rapid on-site evaluation of endobronchial ultrasound-guided transbronchial fine needle aspiration","volume":"19","author":"Khurana","year":"2013","journal-title":"Telemed J E Health"},{"issue":"2","key":"10.1016\/j.chest.2021.06.065_bib36","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.athoracsur.2013.04.003","article-title":"Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging","volume":"96","author":"Joseph","year":"2013","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"10.1016\/j.chest.2021.06.065_bib37","first-page":"253","article-title":"Rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspirations for\u00a0the\u00a0diagnosis of lung cancer: a perspective from members of the\u00a0Pulmonary Pathology Society","volume":"142","author":"Jain","year":"2018","journal-title":"Arch\u00a0Pathol Lab Med"},{"issue":"3","key":"10.1016\/j.chest.2021.06.065_bib38","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1378\/chest.15-1216","article-title":"technical aspects of endobronchial\u00a0ultrasound-guided transbronchial needle aspiration:\u00a0CHEST\u00a0Guideline and Expert Panel\u00a0Report","volume":"149","author":"Wahidi","year":"2016","journal-title":"Chest"},{"issue":"6","key":"10.1016\/j.chest.2021.06.065_bib39","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1159\/000368857","article-title":"Guideline for the acquisition and preparation of conventional and endobronchial ultrasound-guided transbronchial needle aspiration specimens for the diagnosis and molecular testing of patients with known or suspected lung cancer","volume":"88","author":"van der Heijden","year":"2014","journal-title":"Respiration"},{"issue":"5","key":"10.1016\/j.chest.2021.06.065_bib40","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1017\/S0266462315000513","article-title":"Cost analysis\u00a0of\u00a0intra-procedural rapid on\u00a0site\u00a0evaluation of cytopathology with\u00a0endobronchial ultrasound","volume":"31","author":"Kalluri","year":"2015","journal-title":"Int J Technol Assess Health Care"}],"container-title":["Chest"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369221013143?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0012369221013143?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T23:01:03Z","timestamp":1762124463000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0012369221013143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":39,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["S0012369221013143"],"URL":"https:\/\/doi.org\/10.1016\/j.chest.2021.06.065","relation":{},"ISSN":["0012-3692"],"issn-type":[{"value":"0012-3692","type":"print"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Optimizing Diagnostic and Staging Pathways for Suspected Lung Cancer","name":"articletitle","label":"Article Title"},{"value":"Chest","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.chest.2021.06.065","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}