Mediastinal staging in daily practice: endosonography, followed by cervical mediastinoscopy. Do we really need both?

Schuurbiers, Olga C.J.; Looijen-Salamon, Monika; Heide, Stefan M. van der; Swieten, Henry A. van; Heijden, Erik H F M van der

doi:10.1093/icvts/ivt302

Cited by 20 publications

(21 citation statements)

References 16 publications

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“…The remaining 42 records were assessed in the full text. Of those, 14 were included as they corresponded to the search criteria ( Table 1) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The size of the cohorts varied from 30 to 802 patients, with a total number of 3,550 patients.…”

Section: Methodsmentioning

confidence: 99%

Endobronchial ultrasound-transbronchial needle aspiration (EBUS/TBNA): a diagnostic challenge for mediastinal lesions

et al. 2018

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Lung cancer is one of the most frequent neoplastic diseases. To date, most lung cancer is diagnosed at an advanced stage, making it difficult to choose the diagnostic and therapeutic strategy. Surgical resection represents the best therapeutic solution. However, the best results are obtained only in the early stages of the disease. Lymph node involvement conditions the treatment (surgical or non-surgical approach). Mediastinoscopy is an effective and widely used method for mediastinal staging but does not allow us to reach many mediastinal lymph nodes. Endobronchial ultrasound/transbronchial needle aspiration (EBUS-TBNA) allows us to reach more lymph nodes and is referred to as a first-choice exam for mediastinal staging.

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Section: Methodsmentioning

confidence: 99%

Endobronchial ultrasound-transbronchial needle aspiration (EBUS/TBNA): a diagnostic challenge for mediastinal lesions

et al. 2018

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“…Six of 32 unique studies reported transparently on subgroups of patients undergoing mediastinal staging by different staging strategies (i.e., EBUS and/or EUS with or without mediastinoscopy) within one study. 13,24,29,[31][32][33] For assessment of the rates of unforeseen N2 disease for the various different staging strategies, these studies were subdivided in subgroups according to the strategy used. Details on the subdivided studies are provided in Appendix D in the Supplementary Data.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Of these studies, 12 evaluated EBUS, [11][12][13][14][15][16][17][18][19][20][21][22] seven evaluated EUS, 13,[23][24][25][26][27][28] and 12 evaluated combined EBUS and EUS as a staging method. 13,[29][30][31][32][33][34][35][36][37] One study was a randomized controlled trial (RCT) comparing staging by EBUS followed by EUS versus EUS followed by EBUS, and one study was an observational study comparing EBUS plus EUS versus EBUS plus EUS with use of the EBUS scope. These studies were divided into four subgroups for meta-analysis.…”

Section: Description Of Studiesmentioning

confidence: 99%

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Bousema

Dorp

Noyez³

et al. 2019

Journal of Thoracic Oncology

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Introduction: Confirmatory mediastinoscopy after negative endosonography findings is advised by the guidelines on patients with resectable NSCLC and suspected intrathoracic nodes on fludeoxyglucose F 18 positron emission tomography-computed tomography. Its role however is under debate owing to its limited nodal metastasis detection rate, morbidity, associated treatment delay, and unknown impact on survival. Methods: Systematic review and meta-analysis of studies on invasive mediastinal staging in patients with (suspected) NSCLC. The Medline, Embase, and Cochrane databases were searched until September 19, 2018, without year or language restrictions. The Quality Assessment Tool for Diagnostic Accuracy Studies, version 2, was used to evaluate the risk of bias and applicability of the included studies. Rates of unforeseen N2 disease were assessed for endobronchial ultrasound and/or endoscopic ultrasound staging strategies with or without confirmatory mediastinoscopy. Additionally, the complication rates of cervical video mediastinoscopy for mediastinal staging of NSCLC were investigated. Results: A total of 5073 articles were found, of which 42 studies or subgroups (covering a total of 3248 patients undergoing the surgical reference standard of treatment) were considered in the analysis. Random effects metaanalysis of endosonography with or without confirmatory mediastinoscopy showed rates of unforeseen N2 disease of 9.6% (95% confidence interval [CI]: 7.8%-11.7%, I 2 ¼ 30%) versus 9.9% (95% CI: 6.3%-15.2%, I 2 ¼ 73%), respectively. Random effects meta-analysis of mediastinoscopy (eight studies [1245 patients in total]) showed a complication rate of 6.0% (95% CI: 4.8%-7.5%), with laryngeal recurrent nerve palsy accounting for 2.8% (95% CI: 2.0%-4.0%). Conclusion: The rate of unforeseen N2 disease after negative endosonography findings was similar in patients undergoing immediate lung tumor resection to those undergoing confirmatory mediastinoscopy first, at the cost of 6.0% rate of complications by mediastinoscopy.

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“…Therefore, we would like to emphasise the need for continued outcomes-based measures of quality, individually and institutionally, reviewing the negative predictive value and diagnostic accuracy of EBUS/EUS procedures and preoperative mediastinal nodal staging in general on a regularly basis. In our own institution, we found 8.8 mediastinoscopies have to be performed to prevent one futile thoracotomy after negative endoscopic staging [9], a number which is lowered to 6.1 when patients have suspicious mediastinal lymph nodes on fluorodeoxyglucose-positron emission tomography. Specifically for cN1-patients, 10 mediastinoscopies are needed to detect one false-negative N2 on endosonography [10].…”

mentioning

confidence: 88%

Mediastinoscopy after negative endoscopic mediastinal nodal staging: can it be omitted?

Heijden

2015

Eur Respir J

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Mediastinal staging in daily practice: endosonography, followed by cervical mediastinoscopy. Do we really need both?

Abstract: In patients with a high probability of mediastinal metastases, based on imaging, and negative endosonography, cervical mediastinoscopy should not be omitted, not even when the aspirate seems representative.

Cited by 20 publications

References 16 publications

Endobronchial ultrasound-transbronchial needle aspiration (EBUS/TBNA): a diagnostic challenge for mediastinal lesions

Endobronchial ultrasound-transbronchial needle aspiration (EBUS/TBNA): a diagnostic challenge for mediastinal lesions

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Mediastinoscopy after negative endoscopic mediastinal nodal staging: can it be omitted?

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