Integral mediastinal staging in patients with NON-SMALL cell lung cancer and risk factors for occult N2 disease.

Autor: Lucena CM; Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Martin-Deleon R; Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Boada M; Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Marrades RM; Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Sánchez D; Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Sánchez M; Radiology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Vollmer I; Radiology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Martínez D; Pathology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Fontana A; Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Reguart N; Medical Oncology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain., Molins L; Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain., Agustí C; Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain. Electronic address: cagusti@clinic.cat.
Jazyk: angličtina
Zdroj: Respiratory medicine [Respir Med] 2023 Mar; Vol. 208, pp. 107132. Date of Electronic Publication: 2023 Jan 30.
DOI: 10.1016/j.rmed.2023.107132
Abstrakt: Background: In patients with non-small cell lung cancer (NSCLC), the presence of abnormal hiliar lymph nodes (clinical N1; cN1), central tumor location and/or tumor size (diameter >3 cm) increases the risk of occult mediastinal metastasis (OMM). This study investigates prospectively the diagnostic value of an integral mediastinal staging (IMS) strategy that combines EndoBronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) and Video-Assisted Mediastinoscopy (VAM) in patients with NSCLC at risk of OMM.
Methods: Patients with NSCLC and radiologically normal mediastinum assessed non-invasively by positron emission tomography and computed tomography of the chest (PET-CT), and OMM risk factors (cN1, central tumor and/or >3 cm) underwent EBUS-TBNA followed by VAM if the former was negative. Those with negative IMS underwent resection surgery of the tumor.
Results: EBUS-TBNA identified OMM in 2 out of the 49 patients evaluated (4%) and VAM in 1 of the 47 patients with negative EBUS (2%). Two patients with a negative IMS had OMM at surgery. Overall, the prevalence of OMM was 10%. EBUS-TBNA has a sensitivity of 40%, a negative predictive value (NPV) of 93.6%, and negative likelihood ratio of 0.60 (95%CI:0.30-1.16). The risk of not diagnosing OMM after EBUS was 6% and after IMS was 4.4%.
Conclusion: Integral mediastinal staging in patients with NSCLC and clinical risk factors for OMM, does not seem to provide added diagnostic value to that of EBUS-TBNA, except perhaps in patients with cN1 disease who deserve further research.
Competing Interests: Declaration of competing interest NR reports having received research grant suport from Pfizer and personal fees from Roche, MSD, Takeda, Amgen, Bayer and Pfizer, outside the submitted work. CML, RMD, MB, RMM, DS, MS, IV, DM, AF, LM, CA have no conflicts of interest to declare.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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