Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer

Annema, Jouke T.; Meerbeeck, Jan P. van; Rintoul, Robert C.; Dooms, Christophe; Deschepper, Ellen; Dekkers, Olaf M.; Leyn, Paul De; Braun, Jerry; Carroll, Nicholas; Praet, Marleen; Ryck, Frédéric De; Vansteenkiste, Johan; Vermassen, Frank; Versteegh, Michel I.M.; Veselic, Maud; Nicholson, Andrew G.; Rabe, Klaus F.; Tournoy, Kurt G.

doi:10.1001/jama.2010.1705

Cited by 534 publications

(407 citation statements)

References 28 publications

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“…Therefore, while diagnostic accuracy of EBUS-TBNA for detection of NSCLC matches [30], or even exceeds [31], that of mediastinoscopy, the accuracy in determination of NSCLC subtype remains unclear. One study examined accuracy of EBUS-TBNA in subtype determination in 23 specimens (retrospectively selected from over 1,800 EBUS-TBNA procedures performed) [32].…”

Section: Lung Cancer Dp Steinfort Et Almentioning

confidence: 99%

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

et al. 2012

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Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) may diagnose suspected lung cancer. Determination of non-small cell lung cancer (NSCLC) subtype may guide therapy in select patients. Small-volume biopsies may be subject to significant interobserver variability in subtype determination.Three pathologists independently reviewed specimens from 60 patients who underwent EBUS-TBNA for diagnosis/staging of suspected/known NSCLC. Smear, haematoxylin and eosin (H&E) and immunohistochemistry (IHC) specimens were reviewed without reference to other specimen types obtained from the same patient. Final diagnoses, and degree of confidence in the diagnosis, were recorded for each specimen.Almost perfect agreement was seen for distinguishing between small cell lung cancer and NSCLC for all specimen types. Agreement in determination of NSCLC subtype for smear, H&E and IHC specimens was slight (k50.095, 95% CI -0.164-0.355), fair (k50.278, 95% CI 0.075-0.481) and moderate (k50.564, 95% CI 0.338-0.740), respectively. Perfect agreement was seen when all three observers were confident of diagnoses made on IHC specimens.Interobserver agreement in interpretation of EBUS-TBNA specimens is moderate for determination of NSCLC subtype. Agreement is highest following examination of IHC specimens. Clinicians should be aware of the degree of pathologist confidence in the tissue diagnosis prior to commencement of subtype-specific therapy for NSCLC.

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Section: Lung Cancer Dp Steinfort Et Almentioning

confidence: 99%

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

et al. 2012

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“…The sensitivity of EBUS increased to 94% in a subgroup of patients selected with imaging compared with only 76% in patients who had no PET or CT selection. The ASTER [Assessment of Surgical sTaging versus EBUS and endoscopic ultrasound (EUS) in lung cancer: a Randomized controlled trial] study randomized 241 patients with resectable lung cancer with enlarged or FDG-avid hilar or mediastinal lymph nodes or a central lung lesion to immediate surgical staging or minimally invasive staging with EBUS and EUS followed by surgical staging if no mediastinal nodal metastases were found (21). The combination strategy resulted in sensitivity of 94% (95% CI, 85%-98%) compared with only 79% (95% CI, 66%-88%) with surgical staging alone (P ¼ 0.02).…”

Section: Stagingmentioning

confidence: 99%

Advances in the Diagnosis and Treatment of Non–Small Cell Lung Cancer

Pillai

Ramalingam

2014

Molecular Cancer Therapeutics

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The diagnostic and therapeutic landscape of non-small cell lung cancer (NSCLC) has changed dramatically in the past 50 years since the Surgeon General's report on smoking and lung cancer. Early detection is now a reality for lung cancer. The use of low-dose computed tomography scans for early detection decreases mortality and is beginning to be used in routine clinical practice. Technological advances such as positron emission tomography and endobronchial ultrasound have improved the accuracy of NSCLC staging. The cure rate for early-stage NSCLC has improved as a result of multimodality treatment approaches.

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“…Cerfolio et al found in these patients that EBUS-TBNA and EBUS-FNA had a NPV of 79% and sensitivity of only 57%; EBUS alone had a NPV of 80% and sensitivity of 63% but mediastinoscopy faired significantly better with 88% sensitivity, 93% NPV and 95% accuracy. 6 Despite these findings many have used the alternative results of the Assessment of Surgical sTaging vs Endoscopic ultrasound in lung cancer: a Randomised clinical (ASTER) trial to promote EBUS-TBNA and EBUS-FNA as the first staging procedure. 7 In the group staged by mediastinoscopy the false negative rate was unusually high and 18% of subsequent operations were for N2 disease.…”

Section: Preoperative Staging Must Be Comparable With Intraoperative mentioning

confidence: 99%

Is there still a role for mediastinoscopy as the first mediastinal staging procedure in lung cancer?

Waller

Skwarski²

2013

J R Coll Physicians Edinb

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DeClaRaTION Of INTeResTs No conflicts of interest declared.aBsTRaCT Lung cancer staging has evolved with the advent of endobronchial and endoscopic ultrasound (EBUS and EUS) as an alternative to mediastinoscopy and other surgical staging techniques. This has led to the debate now as to what the first-line staging investigation should be. Mr Waller makes the case that although EBUS and EUS are welcomed staging techniques, mediastinoscopy still has an important role as the first-line staging investigation in specific scenarios (when there is potentially surgically resectable mediastinal disease). Dr Skwarski argues that EBUS and EUS should be used in conjunction with CT-PET and considered as a complete alternative to mediastinoscopy.aBsTRaCT In the face of increasing evidence of the efficacy of endoluminal ultrasonic biopsy methods (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and endoscopic ultrasound-guided fine needle aspiration [EUS-FNA]) it would seem perverse to argue that a more invasive surgical operation such as mediastinoscopy should be preferred as a first-line investigation. However, more careful study of the indication for staging and developments in the technique of mediastinoscopy will identify specific scenarios where this may be appropriate and will challenge the idiom that EBUS-TBNA and EBUS-FNA is always first choice. J R Coll Physicians Edinb 2013; 43:137-43 To justify operating primarily on this evidence one must duplicate the standard of operative staging prior to the procedure. In other words the mediastinal nodes must be removed in order to be certain that only one zone is malignant. The EBUS-TBNA and EBUS-FNA does not have a sufficiently high negative predictive value (NPV) to fulfil these requirements. In the radiologically normal mediastinum (with no enlarged nodes), EBUS-TBNA and EBUS-FNA is highly effective with a sensitivity of up to 68% and a NPV of 91%.4 Yasufuku et al. found no significant differences between EBUS-TBNA and EBUS-FNA and mediastinoscopy in determining the true pathologic N stage in a population in which the prevalence of N2/N3 disease was 35%.5 So a negative EBUS-TBNA and EBUS-FNA means that a surgical diagnostic exploration of the mediastinum may be omitted. However, in potential surgical patients with suspected N2 disease on a positron emission tomography-computed tomography (PET-CT) scan, the conclusions are somewhat different. Cerfolio et al. found in these patients that EBUS-TBNA and EBUS-FNA had a NPV of 79% and sensitivity of only 57%; EBUS alone had a NPV of 80% and sensitivity of 63% but mediastinoscopy faired significantly better with 88% sensitivity, 93% NPV and 95% accuracy.6 Despite these findings many have used the alternative results of the Assessment of Surgical sTaging vs Endoscopic ultrasound in lung cancer: a Randomised clinical (ASTER) trial to promote EBUS-TBNA and EBUS-FNA as the first staging procedure. 7 In the group staged by mediastinoscopy the false negative rate was unusually high and 18% of subsequent o...

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Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer

Cited by 534 publications

References 28 publications

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Interobserver agreement in determining non-small cell lung cancer subtype in specimens acquired by EBUS-TBNA

Advances in the Diagnosis and Treatment of Non–Small Cell Lung Cancer

Is there still a role for mediastinoscopy as the first mediastinal staging procedure in lung cancer?

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