Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study.

Autor:	Decaluwé H; Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium Herbert.decaluwe@uzleuven.be., Dooms C; Dept of Pneumology, University Hospitals Leuven, Leuven, Belgium., D'Journo XB; Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France., Call S; Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain., Sanchez D; Dept of Thoracic Surgery, Hospital Clinic, Barcelona University, Barcelona, Spain., Haager B; Dept of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany., Beelen R; Dept of Cardiovascular and Thoracic Surgery, OLV Ziekenhuis, Aalst, Belgium., Kara V; Dept of Thoracic Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey., Klikovits T; Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria., Aigner C; Dept of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany., Tournoy K; Dept of Pneumology, OLV Ziekenhuis, Aalst, Belgium., Zahin M; Dept of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany., Moons J; Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium., Brioude G; Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France., Trujillo JC; Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain., Klepetko W; Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria., Turna A; Dept of Thoracic Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey., Passlick B; Dept of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany., Molins L; Dept of Thoracic Surgery, Hospital Clinic, Barcelona University, Barcelona, Spain., Rami-Porta R; Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain., Thomas P; Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France., Leyn P; Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2017 Dec 21; Vol. 50 (6). Date of Electronic Publication: 2017 Dec 21 (Print Publication: 2017).
DOI:	10.1183/13993003.01493-2017
Abstrakt:	A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography-computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multicentre trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAMLA).Consecutive patients with operable and resectable (suspected) NSCLC and cN1 after PET-CT imaging underwent VAM(LA). The primary study outcome was sensitivity to detect N2 disease. Secondary endpoints were the prevalence of N2 disease, negative predictive value (NPV) and accuracy of VAM(LA).Out of 105 patients with cN1 on imaging, 26% eventually developed N2 disease. Invasive mediastinal staging with VAM(LA) had a sensitivity of 73% to detect N2 disease. The NPV was 92% and accuracy 93%. Median number of assessed lymph node stations during VAM(LA) was 4 (IQR 3-5), and in 96%, at least three stations were assessed.VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1 lung cancer, and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with a one in four chance of occult-positive mediastinal nodes after negative PET-CT. Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com (Copyright ©ERS 2017.)
Databáze:	MEDLINE
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