Incidence and clinical relevance of non-small cell lung cancer lymph node micro-metastasis detected by staging endobronchial ultrasound-guided transbronchial needle aspiration.

Autor:	Belanger AR; Section of Interventional Pulmonology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Hollyfield J; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA., Yacovone G; Lineberger Comprehensive Cancer Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Ceppe AS; Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Akulian JA; Section of Interventional Pulmonology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Burks AC; Section of Interventional Pulmonology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Rivera MP; Section of Interventional Pulmonology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Dodd LG; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USA., Long JM; Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA., Haithcock BE; Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA., Pecot CV; Lineberger Comprehensive Cancer Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2019 Aug; Vol. 11 (8), pp. 3650-3658.
DOI:	10.21037/jtd.2019.05.36
Abstrakt:	Background: Approximately twenty percent of lymph node (LN) negative non-small cell lung cancer (NSCLC) patients who undergo curative intent surgery have pan-cytokeratin immunohistochemistry (IHC)-detectable occult micro-metastases (MMs) in resected LNs. The presence of the MMs in NSCLC is associated worsened outcomes. As a substantial proportion of NSCLC LN staging is conducted using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), we sought to determine the frequency of detection of occult MMs in EBUS-TBNA specimens and to evaluate the impact of MMs on progression-free and overall survival. Methods: We performed retrospective IHC staining for pan-cytokeratin of EBUS-TBNA specimens previously deemed negative by a cytopathologist based on conventional hematoxylin and eosin staining. The results were correlated with clinical variables, including survival outcomes. Results: Of 887 patients screened, 44 patients were identified meeting inclusion criteria with sufficient additional tissue for testing. With respect to the time of the EBUS-TBNA procedure, 52% of patients were clinical stage I, 34% clinical stage II, and clinical 14% stage IIIa NSCLC. Three patients (6.8%) were found to have cytokeratin positive MMs. All 3 MMs detected were at N2 LN stations. The presence of MMs was associated with significantly decreased progression-free (median 210 vs. 1,293 days, P=0.0093) and overall survival (median 239 vs. 1,120 days, P=0.0357). Conclusions: Occult LN MMs can be detected in EBUS-TBNA specimens obtained during staging examinations and are associated with poor clinical outcomes. If prospectively confirmed, these results have significant implications for EBUS-TBNA specimen analyses and possibly for the NSCLC staging paradigm. Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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