Preoperative Staging by EBUS in cN0/N1 Lung Cancer

Leong, Tracy L.; Loveland, Paula; Gorelik, Alexandra; Irving, Louis; Steinfort, Daniel P.

doi:10.1097/lbr.0000000000000545

Cited by 68 publications

(83 citation statements)

References 56 publications

(103 reference statements)

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“…Two recent meta-analyses have reported the prevalence of occult LN metastasis to range from 12.8% to 15.0% in NSCLC patients with CT-negative LNs. 10,11 In the present study, nearly half of small-sized LNs (68/149, 45.6%) were finally diagnosed as malignant. This could be attributed to the inclusion of LNs with a high SUVmax.…”

Section: Figurementioning

confidence: 44%

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Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

et al. 2020

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Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.

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Section: Figurementioning

confidence: 44%

“…8,9 Two additional meta-analyses which evaluated the use of EBUS-TBNA for radiologically normal-size (CT-negative) LNs in NSCLC patients, reported high negative predictive values (NPVs), ranging from 91% to 93%. 10,11 Therefore, the utility of EBUS-TBNA for CTnegative LNs has already been established.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

et al. 2020

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“…A systemic approach by the sampling of all mediastinal and hilar lymph nodes larger than 5 mm rather than a "targeted approach" whereby only abnormal lymph nodes seen on imaging are sampled, may result in fewer missed lymph nodes and thereby improved sensitivity. This approach has shown to reduce the number of subjects requiring upstaging after surgical procedure (20). Sampling of nodes in the order of N3 to N1 station is also recommended to avoid false diagnosis of higher stage of lung cancer (21).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) in Real Life

et al. 2020

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Background: EBUS-TBNA is an integral tool in the diagnosis and staging of lung cancer and other diseases involving mediastinal lymphadenopathy. Most studies attesting to the performance of EBUS-TBNA are prospective analyses performed under strict protocols. The objective of our study was to compare the accuracy of EBUS-TBNA to surgery in diagnosing hilar and mediastinal pathologies in a tertiary hospital, staffed by pulmonologists with and without formal interventional pulmonary training. Methods: We retrospectively analyzed subjects who underwent EBUS-TBNA followed by a confirmatory surgical procedure from January 2012 to December 2018. The primary outcome was to evaluate the accuracy of EBUS-TBNA in the diagnosis of all mediastinal disease. Secondary analyses determined the accuracy of EBUS-TBNA in cancer, NSCLC, and non-malignant lesions individually. Results: One hundred and forty-three subjects had an EBUS-TBNA procedure followed by surgery. EBUS-TBNA for all pathologies had an accuracy of 81.2% (CI 95% 73.8-87.4) and sensitivity of 55.1% (CI 95% 41.5-68.3). The accuracy and sensitivity of individual groups were: cancer (81.7, 48.8%), NSCLC (84, 48.3%), and non-malignancy (78.9, 60%). The NSCLC group had 15 false negatives and 5 (33.3%) of them were due to non-sampling of EBUS accessible nodes. Missed sampling led to a change in the final staging in 8.6% of NSCLC subjects. Conclusion: The accuracy of EBUS-TBNA across all groups was comparable to those reported previously. However, the sensitivity was comparatively lower. This was primarily due to the large number of EBUS-TBNA accessible lymph nodes that were not sampled. This data highlights the need for guidelines outlining the best sampling approach and lymph node selection.

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“…Many centres would undertake minimally invasive mediastinal LN staging patients with cN1 findings on PET due to the elevated risk of post-operative upstaging to N2 in this group. 17 However, given the current risks and potentially reduced sensitivity of EBUS/endoscopic staging in this patient subset, 17,18 we suggest that such patients undergo percutaneous biopsy of the primary tumour prior to surgical resection, or may even be appropriate for surgical resection without a tissue diagnosis, given the high likelihood of malignancy.…”

Section: Stage IImentioning

confidence: 99%

Safe performance of diagnostic bronchoscopy/EBUS during the SARS‐CoV‐2 pandemic

et al. 2020

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The SARS-CoV-2 pandemic is unprecedented in our professional lives and much effort and resources will be devoted to care of patients (and HCW) affected by this illness. We must also continue to aim for the same standard of care for our non-COVID respiratory patients, while minimizing risks of infection transmission to our colleagues. This commentary addresses the key paired issues of minimizing performance of diagnostic/staging bronchoscopy in patients with suspected/known lung cancer while maximizing the safety of the procedure with respect to HCW transmission of COVID-19.

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Preoperative Staging by EBUS in cN0/N1 Lung Cancer

Cited by 68 publications

References 56 publications

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

Diagnostic Accuracy of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) in Real Life

Safe performance of diagnostic bronchoscopy/EBUS during the SARS‐CoV‐2 pandemic

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