几个地方没怎么看懂？

At present, there is insufficient evidence to clearly define the role of surgical and endoscopic modalities in patients with advanced lung cancer and considered for trimodality therapy and in setting of suspected recurrent lung cancer. However, recently, literature has emerged on cost-effectiveness of mediastinal LN staging in this patient population [25]. In a population with high prevalence of mediastinal nodal metastasis, EBUS-TBNA followed by Med has been shown to be the most cost-effective strategy, suggesting a clear role for confirmatory Med in some patients while advocating for EBUS-TBNA as the test of first choice for invasive staging.Studies demonstrate that EBUS-TBNA sensitivity and prevalence of mediastinal nodal metastasis are important factors in deciding on the most cost-effective staging modality. Recent study showed that if the EBUS-TBNA sensitivity of at least 25% cannot be achieved, Med should be the preferred staging strategy, proving that the previous“gold standard” is still preferred over poorly performed endoscopic staging.

目前，没有足够的证据明确手术和内镜方式在晚期肺癌患者中的作用，并考虑疑似肺癌复发时三重治疗。然而，关于该人群纵隔LN分期成本效益的最近文献^[25]显示，在纵隔淋巴结多处转移的患者中，EBUS-TBNA后再行Med最具成本效益，这表明尽管提倡将EBUS-TBNA作为有创性分期的首选检测，但在某些患者中确证性Med具有明确作用^[25]。研究表明，EBUS-TBNA对纵隔淋巴结转移的敏感度和检出率是决定分期策略时成本效益的最重要因素。最近的研究表明，若EBUS-TBNA敏感度未达到≥25%，Med应是首选的分期策略，这证明了当内镜分期效果不佳时，Med（之前的“金标准”）仍然首选^[25,132]。

几个地方没怎么看懂？谢谢