Diagnostic performance of endobronchial ultrasound-guided mediastinal lymph node sampling in early stage non-small cell lung cancer: A prospective study

被引:51
作者
Vial, Macarena R. [1 ,7 ]
O'Connell, Oisin J. [1 ]
Grosu, Horiana B. [1 ]
Hernandez, Mike [2 ]
Noor, Laila [1 ]
Casal, Roberto F. [1 ,3 ]
Stewart, John [4 ]
Sarkiss, Mona [5 ]
Jimenez, Carlos A. [1 ]
Rice, David [6 ]
Mehran, Reza [6 ]
Ost, David E. [1 ]
Eapen, George A. [1 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Dept Pulm Med, Unit 1462,1515 Holcombe Blvd, Houston, TX 77030 USA
[2] Univ Texas MD Anderson Canc Ctr, Dept Biostat, Houston, TX 77030 USA
[3] Baylor Coll Med, Michael E DeBakey Vet Affairs, Dept Pulm & Crit Care Med, Houston, TX 77030 USA
[4] Univ Texas MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USA
[5] Univ Texas Hlth Sci Ctr Houston, Dept Anesthesiol & Perioperat Med, Houston, TX 77030 USA
[6] Univ Texas MD Anderson Canc Ctr, Dept Thorac Surg, Houston, TX 77030 USA
[7] Univ Desarrollo, Clin Alemana Santiago, Intervent Pulmonol Unit, Dept Pulm Med, Santiago, Chile
基金
美国国家卫生研究院;
关键词
bronchoscopy; carcinoma; endosonography; neoplasm staging; non-small cell lung; POSITRON-EMISSION-TOMOGRAPHY; TRANSBRONCHIAL NEEDLE ASPIRATION; COMPUTED-TOMOGRAPHY; ENDOSONOGRAPHY; CLASSIFICATION;
D O I
10.1111/resp.13162
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background and objectiveStandard nodal staging of lung cancer consists of positron emission tomography/computed tomography (PET/CT), followed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) if PET/CT shows mediastinal lymphadenopathy. Sensitivity of EBUS-TBNA in patients with N0/N1 disease by PET/CT is unclear and largely based on retrospective studies. We assessed the sensitivity of EBUS-TBNA in this setting. MethodsWe enrolled patients with proven or suspected lung cancer staged as N0/N1 by PET/CT and without metastatic disease (M0), who underwent staging EBUS-TBNA. Primary outcome was sensitivity of EBUS-TBNA compared with a composite reference standard of surgical stage or EBUS-TBNA stage if EBUS demonstrated N2/N3 disease. ResultsSeventy-five patients were included in the analysis. Mean tumour size was 3.52cm (1.63). Fifteen of 75 patients (20%) had N2 disease. EBUS-TBNA identified six while nine were only identified at surgery. Sensitivity of EBUS-TBNA for N2 disease was 40% (95% CI: 16.3-67.7%). ConclusionA significant proportion of patients with N0/N1 disease by PET/CT had N2 disease (20%) and EBUS-TBNA identified a substantial fraction of these patients, thus improving diagnostic accuracy compared with PET/CT alone. Sensitivity of EBUS-TBNA however appears lower compared with historical data from patients with larger volume mediastinal disease. Therefore, strategies to improve EBUS-TBNA accuracy in this population should be further explored We assessed the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with lung cancer staged as N0/N1 by positron emission tomography/computed tomography (PET/CT). EBUS-TBNA improved the pretreatment staging of these patients compared with PET/CT; however, the sensitivity for N2 disease is only 40%, lower than sensitivities previously reported for N2/N3 patients.
引用
收藏
页码:76 / 81
页数:6
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