Chest
Original Research: Lung CancerEndosonography for Mediastinal Nodal Staging of Clinical N1 Non-small Cell Lung Cancer
Section snippets
Materials and Methods
Patients with operable and resectable (suspected) NSCLC were eligible for the study if they had cN1 disease after an integrated whole-body PET/CT scan. The cN1 was based on either an enlarged hilar N1 lymph node on CT scan or visual FDG uptake on PET scan in a hilar N1 lymph node. The FDG uptake within the lymph node was compared with the background FDG accumulation in the mediastinal vessel pool and reported positive whenever an FDG uptake higher than the background uptake in the mediastinal
Results
Between December 2009 and September 2013, 100 consecutive patients with operable and resectable (suspected) cN1 NSCLC were included (Fig 1). The clinical patient characteristics are shown in Table 1.
Discussion
The most important findings of this study are that one in four patients with cN1 lung cancer on imaging ends up with N2 disease and that invasive staging with endosonography alone has a sensitivity of 38% to detect N2 disease, which can be increased to 73% by adding a mediastinoscopy. The recommendation to use endosonography as the preoperative mediastinal staging tool of choice for all patients with lung cancer with a suspicion for mediastinal nodal involvement is based on data from several
Acknowledgments
Author contributions: C. D. is responsible for the overall content. C. D., K. G. T., and P. D. L. contributed to planning of the work and C. D., K. G. T., O. S., H. D., F. D. R., A. V., R. B., E. v. d. H., and P. D. L. contributed to the study and the drafting, review, and approval of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr van der Heijden has received a research grant from Pentax Medical and travel
References (16)
- et al.
Problems in diagnosis and surgical management of clinical N1 non-small cell lung cancer
Ann Thorac Surg
(2005) - et al.
Improving the inaccuracies of clinical staging of patients with NSCLC: a prospective trial
Ann Thorac Surg
(2005) - et al.
Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
(2013) - et al.
Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines
Chest
(2013) - et al.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer
Chest
(2008) - et al.
Mediastinal staging of lung cancer: novel concepts
Lancet Oncol
(2012) - et al.
Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer
Chest
(2013) - et al.
Problems in the current diagnostic standards of clinical N1 non-small cell lung cancer
Thorax
(2008)
Cited by (71)
Video-assisted mediastinoscopic lymphadenectomy (VAMLA): Mature results for staging non–small cell lung cancer with normal mediastinum
2024, Journal of Thoracic and Cardiovascular SurgeryA Prediction Model to Optimize Invasive Mediastinal Staging Procedures for Non-small Cell Lung Cancer in Patients With a Radiologically Normal Mediastinum: The Quebec Prediction Model
2021, ChestCitation Excerpt :Although guidelines mention that negative invasive needle technique results should be confirmed in high-risk patients, they do not define high risk. cN1 status has been identified in previous studies8-10 as a potential indicator to pursue more aggressive preoperative mediastinal staging, but other patients with cN0 disease may be at similar or even higher risk of OMD and cN1 patients may be at relatively low risk of OMD. This prediction model allows clinicians to quantify the pretest risk of OMD and provides guidance in the identification of patients who need confirmatory investigations after negative findings from invasive needle techniques.
Completeness of lymph node dissection in patients undergoing minimally invasive- or open surgery for non-small cell lung cancer: A nationwide study
2021, European Journal of Surgical OncologyClinicopathologic Significance of False-Positive Lymph Node Status on FDG-PET in Lung Cancer
2021, Clinical Lung CancerVariation Between Multidisciplinary Tumor Boards in Clinical Staging and Treatment Recommendations for Patients With Locally Advanced Non-small Cell Lung Cancer
2020, ChestCitation Excerpt :In this regard, it is also important to be aware of the different indications for mediastinal staging; the risk of unforeseen N2 nodes is higher in clinical N1 or N2 nodes on PET-CT imaging compared with the risk of unforeseen N2 in fluorodeoxyglucose-negative tumors, central tumors, or tumors larger than 3 cm. Furthermore, EBUS has a low sensitivity compared with mediastinoscopy in clinical N1 disease.23 Some groups even advocate omitting EBUS in this patient group and perform only mediastinoscopy.24
Drs Dooms and Tournoy contributed equally to this manuscript.
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.