Minimally invasive strategy for mediastinal staging of patients with lung cancer

Pol Arch Med Wewn. 2015;125(12):910-3. doi: 10.20452/pamw.3209. Epub 2015 Nov 30.

Abstract

Introduction: The exclusion of mediastinal involvement in patients with non-small cell lung cancer is essential for choosing an appropriate therapy.

Objectives: The aim of the study was to analyze the ability of a new minimally invasive strategy combining positron emission tomography (PET), endobronchial ultrasound needle aspiration (EBUS-NA), and endoscopic ultrasound needle aspiration (EUS-NA) to exclude mediastinal nodal metastases of non-small cell lung cancer.

Patients and methods: In a group of consecutive patients with primary non-small cell lung cancer, the preoperative assessment of medisastinal lymph nodes using PET, EBUS-NA, and EUS-NA. Patients in whom this minimally invasive staging protocol did not confirm mediastinal nodal metastases underwent pulmonary resection with systematic lymph node dissection. The negative predictive values of the combined EBUS-NA/EUS-NA as well as PET/EBUS -NA/EUS-NA were calculated.

Results: We analyzed data of 532 patients (367 men and 165 women; mean age, 65 years [range, 30-84 years]). Squamous carcinoma were diagnosed in 276 patients; adenocarcinoma, in 150; large cell carcinoma, in 22; adenosquamous carcinoma, in 40; small cell carcinoma, in 4; carcinoids, in 21; and other histological types, in 19. We performed 421 lobectomies, 55 pneumonectomies, 51 bilobectomies, and 5 sublobar resections. In all patients, systematic lymph node dissection was performed. The mean number of removed lymph nodes was 22. The negative predictive value of EBUS-NA/EUS-NA was 89.8% and of PET/EBUS-NA/EUS-NA-93.2%.

Conclusions: Patients with lung cancer with negative results of PET, EBUS-NA, and EUS-NA are at low risk of mediastinal nodal metastasis. In these patients, invasive mediastinal staging may not be necessary.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / secondary*
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Female
  • Humans
  • Lung Neoplasms / pathology*
  • Lymphatic Metastasis
  • Male
  • Mediastinal Neoplasms / diagnosis
  • Mediastinal Neoplasms / secondary*
  • Middle Aged
  • Positron-Emission Tomography*