Diagnostic Performance of Endosonography to Detect Mediastinal Lymph Node Metastasis in Patients with Radiological N1 Non–Small Cell Lung Cancer

Kim, Bo‐Guen; Cho, Jong Ho; Shin, Sun Hye; Lee, Kyungjong; Um, Sang‐Won; Kim, Hojoong; Kim, Young Tae; Shim, Young Mog; Jeong, Byeong‐Ho

doi:10.4143/crt.2022.1428

Cited by 3 publications

(7 citation statements)

References 29 publications

(57 reference statements)

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“…Previous studies have shown that patients with central tumors, adenocarcinomas, and solid tumors had a higher prevalence of occult MLN metastases [ 8 , 14 , 26 - 28 ]. Since the prevalence of pN2-3 is high in these conditions, the positive predictive value of eN2-3 by endosonography can be increased and will allow more patients to benefit from proper nodal staging by endosonography.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with active malignancies of other organs at the time of lung cancer diagnosis were excluded. This study includes 315 study participants from a previous study at our center that analyzed the diagnostic performance of endosonography [ 8 ]. In our previous study, we presented information on the prevalence of pN2/N3, the number of lymph nodes (LNs) sampled from N2/N3 stations per patient, and sensitivity in rN1 NSCLC patients undergoing endosonography, comparing it with reports from other institutions [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…Mediastinoscopic staging was rarely performed during the study period. MLND featured en bloc resection of all visible and palpable LNs in the ipsilateral hilum and mediastinum, irrespective of diameter (stations 10R, 9, 8, 7, 4R, 3, and 2R for right-sided tumors and stations 10L, 9, 8, 7, 6, 5 and 4 L for left-sided tumors) [ 8 , 14 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…EBUS-TBNA/EUS-B-FNA procedures were performed under moderate sedation as previously reported [ 8 , 14 ]. In short, EBUS-TBNA was performed from N3 to N2 and then to N1 (short diameter of LN ≥ 5 mm in sonography) after systematic inspection of mediastinal, hilar, and interlobar LNs.…”

Section: Methodsmentioning

confidence: 99%

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Clinical Effect of Endosonography on Overall Survival in Patients with Radiological N1 Non–Small Cell Lung Cancer

Kim,

Jeong,

Park

et al. 2024

Cancer Res Treat

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Purpose It is unclear whether performing endosonography first in non–small cell lung cancer (NSCLC) patients with radiological N1 (rN1) has any advantages over surgery without nodal staging. We aimed to compare surgery without endosonography to performing endosonography first in rN1 on the overall survival (OS) of patients with NSCLC.Materials and Methods This is a retrospective analysis of patients with rN1 NSCLC between 2013 and 2019. Patients were divided into ‘no endosonography’ and ‘endosonography first’ groups. We investigated the effect of nodal staging through endosonography on OS using propensity score matching (PSM) and multivariable Cox proportional hazard regression analysis.Results In the no endosonography group, pathologic N2 occurred in 23.0% of patients. In the endosonography first group, endosonographic N2 and N3 occurred in 8.6% and 1.6% of patients, respectively. Additionally, 51 patients were pathologic N2 among 249 patients who underwent surgery and mediastinal lymph node dissection (MLND) in endosonography first group. After PSM, the 5-year OSs were 68.1% and 70.6% in the no endosonography and endosonography first groups, respectively. However, the 5-year OS was 80.2% in the subgroup who underwent surgery and MLND of the endosonography first group. Moreover, in patients receiving surgical resection with MLND, the endosonography first group tended to have a better OS than the no endosonography group in adjusted analysis using various models.Conclusion In rN1 NSCLC, preoperative endosonography shows better OS than surgery without endosonography. For patients with rN1 NSCLC who are candidates for surgery, preoperative endosonography may help improve survival through patient selection.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Clinical Effect of Endosonography on Overall Survival in Patients with Radiological N1 Non–Small Cell Lung Cancer

Kim,

Jeong,

Park

et al. 2024

Cancer Res Treat

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“…3 The role of EBUS-TBNA for each specific clinical scenario of normal mediastinum on PET/CT where invasive staging is recommended (cN1, ≥T2 and central cT1N0M0) has been scarcely studied. To the best of our knowledge, only two studies 6,7 investigated the usefulness of endosonography in cN1 tumours, both with a reported sensitivity of 38%. Based on this poor sensitivity, some authors have claimed that EBUS-TBNA should not be the technique of choice for invasive mediastinal staging of patients with cN1 tumours.…”

Section: Introductionmentioning

confidence: 99%

EBUS‐TBNA for mediastinal staging of centrally located T1N0M0 non‐small cell lung cancer clinically staged with PET/CT

Serra Mitjà,

García‐Cabo,

Garcia‐Olivé

et al. 2023

Respirology

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Background and ObjectiveTo evaluate the diagnostic accuracy and clinical usefulness of endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) for mediastinal staging of centrally located T1N0M0 non‐small cell lung cancer (NSCLC) clinically staged with positron emission tomography/computed tomography (PET/CT).MethodsWe conducted a study that included patients with centrally located T1N0M0 NSCLC, clinically staged with PET/CT who underwent EBUS‐TBNA for mediastinal staging. Patients with negative EBUS‐TBNA underwent mediastinoscopy, video‐assisted mediastinoscopic lymphadenectomy (VAMLA) and/or lung resection with systematic nodal dissection, that were considered the gold standard. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), overall accuracy of EBUS‐TBNA for diagnosing mediastinal metastases (N2 disease) and the number needed to treat (NNT: number of patients needed to undergo EBUS‐TBNA to avoid a case of pathologic N2 disease after resection) were calculated.ResultsOne‐hundred eighteen patients were included. EBUS‐TBNA proved N2 disease in four patients. In the remaining 114 patients who underwent mediastinoscopy, VAMLA and/or resection there were two cases of N2 (N2 prevalence 5.1%). The sensitivity, specificity, NPV, PPV and overall accuracy for diagnosing mediastinal metastases (N2 disease) were of 66%, 100%, 98%, 100% and 98%, respectively. The NNT was 31 (95% CI: 15–119).ConclusionEBUS‐TBNA in patients with central clinically staged T1N0M0 NSCLC presents a good diagnostic accuracy for mediastinal staging, even in a population with low prevalence of N2 disease. Therefore, its indication should be considered in the management of even these early lung cancers.

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Clinical utility of artificial intelligence–augmented endobronchial ultrasound elastography in lymph node staging for lung cancer

Patel,

Gatti,

Farrokhyar

et al. 2024

JTCVS Techniques

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Diagnostic Performance of Endosonography to Detect Mediastinal Lymph Node Metastasis in Patients with Radiological N1 Non–Small Cell Lung Cancer

Cited by 3 publications

References 29 publications

Clinical Effect of Endosonography on Overall Survival in Patients with Radiological N1 Non–Small Cell Lung Cancer

Clinical Effect of Endosonography on Overall Survival in Patients with Radiological N1 Non–Small Cell Lung Cancer

EBUS‐TBNA for mediastinal staging of centrally located T1N0M0 non‐small cell lung cancer clinically staged with PET/CT

Clinical utility of artificial intelligence–augmented endobronchial ultrasound elastography in lymph node staging for lung cancer

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