Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis

Bousema, Jelle E.; Dorp, Martijn van; Hoeijmakers, Fieke; Huijbregts, Ilse A.; Barlo, Nicole P.; Bootsma, Gerben; Gründeman, Paul F.; Claessens, Niels; Dingemans, Anne‐Marie C.; Hanselaar, Wessel; Kortekaas, R. T.; Lardenoije, Jan-Willem H. P.; Maessen, Jos G.; Schreurs, W. H.; Vissers, Yvonne L. J.; Soud, Maggy Youssef-El; Dijkgraaf, Marcel G. W.; Annema, Jouke T.; Broek, Frank J.C. van den

doi:10.1016/j.lungcan.2019.05.031

Cited by 21 publications

(17 citation statements)

References 19 publications

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“…These studies however, did not provide exact details of the site of occult nodal involvement, or, did not strictly follow endoscopic and surgical staging guidelines. A recent meta-analysis investigating unforeseen N2 disease showed a 9.6 % (95 % CI 7.8 %-11.7 %) unforeseen N2 rate in endosonography with confirmatory mediastinoscopy versus 9.9 % (95 %CI: 6.3 %-15.2 %) in endosonography without confirmatory mediastinoscopy (n = 3248) [27]. Both reported numbers are in range, but slightly higher than found in our study (overall 7.2 % of our patients had occult pN2).…”

Section: Discussionmentioning

confidence: 99%

“…Staging guideline adherence remains a problem in clinical practice, since it has been reported to be highly variable, with initially good adherence to the guidelines for endosonographic staging but with poor performance of staging EBUS and frequent omission of confirmatory cervical mediastinoscopies [27]. Adherence to cervical mediastinoscopy guidelines specifically is also low (51-75 %) [49].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies show varying results in accuracy of clinical (mediastinal) staging and incidence of OLM at postoperative pathology [22][23][24][25][26]. This may in part be explained by differences in guideline adherence on mediastinal staging across different hospitals [27]. However, most of these studies focus on the incidence of unforeseen pN2, evaluate the diagnostic value of different staging techniques separately instead of the complete mediastinal staging sequence as a whole, or, do not entirely follow the diagnostic staging sequence as recommended by the ACCP and ESTS guidelines [9,[28][29][30].…”

Section: Introductionmentioning

confidence: 99%

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Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

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Lymph node staging in patients with non-small cell lung cancer is crucial for determining prognosis and treatment. Our objective was to evaluate the clinical-to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC and assess occurrence and distribution of occult lymph node metastases (OLM). Materials and methods: In a retrospective single center cohort study (n = 390), we analyzed all surgically treated NSCLC patients from January 2015 until April 2019. Patients were classified into subgroups (1) mediastinal staging by PET-CT/CT-scan (IMAGE-group) or (2) invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group). Agreement between final clinical (cN) and pathological nodal stage (pN) and the presence and location of OLM are analyzed. Results: Agreement between cN-and pN-stage was 86.3 % in the IMAGE-group (n = 117) and 50.9 % in the INVAS-group (n = 167). Occult N1 disease was found in 33 patients (16.6 % in cN0) of which 52 % occurred in LN-regions 12− 14. Occult N2 disease was found in 20 cases (6.5 % in cN0 and 12.7 % in cN1). Combined, 23.1 % of all pre-operatively cN0-staged patients (n = 46/199) had OLM (pN+), of which 12.1 % (24/199) had metastases in regions 5-6 and/or 12− 14. Of all patients with OLM, 50.0 % (23/46) had primary tumors ≤30 mm. Conclusion: OLM are frequently identified in clinically N0/N1 NSCLC, also in tumors <3 cm, and often in regions beyond reach of current staging techniques. These findings should be addressed when non-surgical treatment or sub-lobar resections are considered for early stage lung cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

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“…So EBUS/EUS as a diagnostic tool seems to be dependable. [10][11][12][13] But the lymph node examination is not all about diagnostics. The VAMLA approach sets itself apart the endoscopic approach due to its additional relevance as a therapeutic intervention.…”

Section: Discussionmentioning

confidence: 99%

Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA): Recipe and Cooking Secrets (a Tutorial)

Huertgen

Tripsky

Hartert

2020

Operative Techniques in Thoracic and Cardiovascular Surgery

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Being a central part in the book of thoracic oncology, correct diagnosis and precise staging of lung cancer is of fundamental interest. As the lung-cancer chapter turned out being more kind of a recipe book of therapeutic possibilities, the list of diagnostic ingredients is not negligible: the various spices consists of different anatomic and metabolic imaging techniques as well as of endoscopies and minimally invasive surgical procedures. Indeed, these staging techniques should be performed well seasoned, that is, sequentially and with an increasing degree of invasiveness. But when it comes to the determination of algorithms on preoperative mediastinal staging, video-assisted mediastinoscopic lymphadenectomy represents indispensably the gold standard when highest accuracy in cytological result is needed. We hereby describe in detail our current operative technique of the video-assisted mediastinoscopic lymphadenectomy procedure, which clarifies its growing up from being just a solely diagnostic and dissection tool to an expert-recognized combined staging and advanced therapeutic tool in the context of minimal invasive lung cancer resection. Operative Techniques in Thoracic and Cardiovasculary Surgery 25:140À170

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“…On the contrary, a maximum standardized uptake value (SUVmax) threshold is associated with a greater number of false-negative findings [ 12 , 13 ]. Mediastinal LN staging by endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA)/mediastinoscopy was reported to be useful and was recommended when LN metastasis is suspected on imaging [ 14 ]. However, there are LNs, including those in stations #5 or #6, which are difficult to evaluate with EBUS-TBNA.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer

et al. 2021

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Background The aim of this study was to assess the diagnostic utility of metabolic parameters on fluorine-18-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) for predicting lymph node (LN) metastasis in patients with cN2 non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed patients who underwent surgery for cN2 NSCLC between 2007 and 2020. Those who had clinically diagnosed positive hilar and mediastinal LNs by routine CT and PET/CT imaging were investigated. To measure the metabolic parameters of LNs, the data according to maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN-to-primary tumor ratio of SUVmax (LPR) were examined. The diagnosis of each retrieved LN was confirmed based on histopathological examination of surgical tissue specimens. Receiver operating characteristics (ROC) curves with area under the curve (AUC) calculations and multivariate analysis by logistic regression were performed. Results Forty-five patients with 84 clinically diagnosed positive hilar or mediastinal LNs were enrolled in the present study. Of the 84 LNs, 63 LNs were pathologically proven as positive (75%). The SUVmax, MTV, TLG, and LPR of LN metastasis were significantly higher than those of benign nodes. In the ROC analysis, the AUC value of LPR [AUC, 0.776; 95% confidence interval (CI), 0.640–0.913] was higher than that of LN SUVmax (AUC, 0.753; 95% CI, 0.626–0.880) or LN TLG3.5 (AUC, 0.746; 95% CI, 0.607–0.885). Using the optimal LPR cutoff value of 0.47, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.1, 66.7, 88.3, 58.3, and 79.8%, respectively. Multivariate analysis by logistic regression showed that LPR was an independent predictor for LN metastasis (odds ratio, 6.45; 95% CI, 1.785–23.301; P = 0.004). In the subgroup analysis of adenocarcinoma patients (n = 18; 32 LNs), TLG3.5 was a better predictor (AUC, 0.816; 95% CI, 0.639–0.985) than LPR (AUC, 0.792; 95% CI, 0.599–0.986) or LN SUVmax (AUC, 0.792; 95% CI, 0.625–0.959). Conclusions Our findings suggest that LPR on FDG-PET is a useful predictor for LN metastasis in patients with cN2 NSCLC. TLG can be a good predictor for LN metastasis in patients with adenocarcinoma.

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Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis

Cited by 21 publications

References 19 publications

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA): Recipe and Cooking Secrets (a Tutorial)

Diagnostic utility of metabolic parameters on FDG PET/CT for lymph node metastasis in patients with cN2 non-small cell lung cancer

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