Clinical efficacy and cost-effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration for preoperative staging of non-small-cell lung cancer: Results of a French prospective multicenter trial (EVIEPEB).

Autor: Chouaid C; Department of Pneumology, CHI Créteil, Créteil, France., Salaün M; Department of Pneumology, CHU de Rouen, Rouen, France., Gounant V; Department of Pneumology CHU Bichat, APHP, Paris, France., Febvre M; Department of Pneumology, CHU Tenon, APHP, Paris, France., Vergnon JM; Department of Pneumology, CHU Saint-Etienne, Saint-Etienne, France., Jouniaux V; Department of Pneumology, CHU d'Amiens, Amiens, France., Fournier C; Department of Pneumology CHU de Lille, Lille, France., Lachkar S; Department of Pneumology, CHU de Rouen, Rouen, France., Hermant C; Department of Pneumology, CHU de Toulouse, Toulouse, France., Raspaud C; Clinique Pasteur Toulouse, Toulouse, France., Quantin X; Department of Pneumology, CHU Montpellier, Montpellier, France., Quiot JJ; Department of Pneumology, CHU Brest, Brest, France., Molard A; Department of Pneumology, CHU Strasbourg, Strasbourg, France., Dayen C; Department of Pneumology, CH Saint-Quentin, Saint-Quentin, France., Marquette CH; Department of Pneumology, CHU Nice, Nice, France., Lena H; Department of Pneumology, CHU de Rennes, Rennes, France., Zalcman G; Department of Pneumology CHU Bichat, APHP, Paris, France., Thiberville L; Department of Pneumology, CHU de Rouen, Rouen, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 Jan 07; Vol. 14 (1), pp. e0208992. Date of Electronic Publication: 2019 Jan 07 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0208992
Abstrakt: This two-step study evaluated the cost-effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for presurgery staging of non-small cell lung cancer (NSCLC) in France (EVIEPEB; ClinicalTrial.gov identifier NCT00960271). Step 1 consisted of a high-benchmark EBUS-TBNA-training program in participating hospital centers. Step 2 was a prospective, national, multicenter study on patients with confirmed or suspected NSCLC and an indication for mediastinal staging with at least one lymph node > 1 cm in diameter. Patients with negative or uninformative EBUS-TBNA and positron-emission tomography-positive or -negative nodes, respectively, underwent either mediastinoscopy or surgery. Direct costs related to final diagnosis of node status were prospectively recorded. Sixteen of 22 participating centers were certified by the EBUS-TBNA-training program and enrolled 163 patients in Step 2. EBUS-TBNA was informative for 149 (91%) patients (75 malignant, 74 non-malignant) and uninformative for 14 (9%). Mediastinoscopy was avoided for 80% of the patients. With a 52% malignant-node rate, EBUS-TBNA positive- and negative-predictive values, respectively, were 100% and 90%. EBUS-TBNA was cost-effective, with expected savings of €1,450 per patient, and would have remained cost-effective even if all EBUS-TBNAs had been performed under general anesthesia or the cost of the procedure had been 30% higher (expected cost-saving of €994 and €1,427 per patient, respectively). After EBUS-TBNA training and certification of participating centers, the results of this prospective multicenter study confirmed EBUS-TBNA cost-effectiveness for NSCLC staging.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje