PURPOSE: Protocols using induction chemotherapy for advanced lung cancer are used with the hope that surgery can be performed after the cancer is down staged. The current restaging modalities either have a low diagnostic accuracy (computed tomography) or can be technically difficult (Re- mediastinoscopy). Endobronchial ultrasound guided TBNA is an excellent tool for mediastinal lymph node staging and may have a role in restaging also.
METHODS: Patients with NSCLC and proven ipsilateral or subcarinal lymph node metastases (N2 disease, 3A disease stage) who had been treated with induction chemotherapy and showing at least stable disease or partial response on CT imaging underwent mediastinal restaging by EBUS-TBNA. This was followed by surgical resection of the tumour with lymph node dissection.
RESULTS: 123 Patients (73 male, 50 female, mean age 58 years) had either a partial response (n=65) or stable disease (n=58) based on sequential CT scans of the thorax. Overall 183 nodes in N2 position were punctured, with a 92 % success rate (lymphocytes or malignant cells). 7 patients were downstaged to N0. The sensitivity, specificity and diagnostic accuracy of EBUS-TBNA per patient in restaging mediastinal LN were 76, 100 and 77%, respectively. EBUS-TBNA was performed in an ambulatory setting. No complications occurred.
CONCLUSION: EBUS-TBNA is an accurate, safe and minimally invasive diagnostic technique for the restaging of mediastinal lymph nodes after induction therapy in NSCLC.
CLINICAL IMPLICATIONS: The routine use of EBUS-TBNA for mediastinal re-staging should be considered.
DISCLOSURE: Felix Herth, No Financial Disclosure Information; No Product/Research Disclosure Information