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

Abstract

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.

Systematic mediastinal staging in non‐small cell lung cancer: Filling in the guideline evidence gap

“…This makes the recent publication by Serra Mitjà and colleagues in Respirology 20 a very significant and welcome contribution to the literature regarding the utility of systematic endoscopic staging in patients with early‐stage NSCLC. In this retrospective study, the authors have reviewed procedural outcomes in patients with centrally positioned T1 (<3 cm) NSCLC who underwent systematic staging with EBUS‐TBNA.…”

“…Based on the findings reported by Serra Mitjà and colleagues, 20 and with the recent publication of the SEISMIC study, 28 there appear to be few patients with non‐metastatic NSCLC who would not benefit from more systematic pre‐operative endoscopic staging. It is hoped that this important study will drive more consistent performance of systematic endoscopic staging in patients with NSCLC, as recommended by the recently published WABIP Expert Panel statement on Quality Indicators in performance of EBUS, 6 and encourage pulmonologists to address barriers to routine use of this simple but effective intervention, which provides crucial information to direct optimal therapeutic decision‐making in non‐metastatic NSCLC.…”