Original Research: Pulmonary Procedures |

Endosonographic Mediastinal Lymph Node Staging of Lung CancerEndosonographic Mediastinal Staging of Lung Cancer

Moishe Liberman, MD, PhD; John Sampalis, PhD; André Duranceau, MD; Vicky Thiffault, RN; Rachid Hadjeres, MD; Pasquale Ferraro, MD
Author and Funding Information

From the CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery (Drs Liberman, Duranceau, and Ferraro and Ms Thiffault), and Department of Pathology (Dr Hadjeres), University of Montréal; Centre Hospitalier de l’Université de Montréal (Drs Liberman, Duranceau, Hadjeres, and Ferraro and Ms Thiffault); and Department of Epidemiology (Dr Sampalis), McGill University, Montréal, QC, Canada.

CORRESPONDENCE TO: Moishe Liberman, MD, PhD, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, Centre Hospitalier de l’Université de Montréal, 1560 rue Sherbrooke Est, 8e CD-Pavillon Lachapelle, Bureau D-8051, Montréal, QC H2L 4M1, Canada; e-mail: moishe.liberman@umontreal.ca

Part of this article has been presented in abstract form at the American Thoracic Society International Conference, May 17-22, 2013, Philadelphia, PA.

FUNDING/SUPPORT: This study was funded by the Canadian Foundation for Innovation, the Society of University Surgeons, and the Fonds de Recherche en Santé du Québec.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;146(2):389-397. doi:10.1378/chest.13-2349
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BACKGROUND:  It is unclear whether endoscopic mediastinal lymph node (LN) staging techniques are equivalent to surgical mediastinal staging (SMS) techniques in patients with potentially operable non-small cell lung cancer (NSCLC).

METHODS:  A total of 166 patients with confirmed or suspected NSCLC who required SMS based on current guidelines were enrolled in this prospective controlled trial comparing endosonographic mediastinal LN staging with SMS. Each patient served as his or her own control. All patients underwent endobronchial ultrasound (EBUS), endoscopic ultrasound (EUS), and SMS during a single procedure. Results of EBUS, EUS, and combined EBUS/EUS were compared with SMS (gold standard) and in patients with negative LN staging results, with LN sampling at pulmonary resection.

RESULTS:  EBUS, EUS, combined EBUS/EUS, and SMS sampled a mean of 2.2, 1.7, 3.9, and 3.1 LN stations, respectively. The prevalence of mediastinal nodal disease (N2/N3) was 32% (53 of 166 patients). The sensitivity, negative predictive value, and diagnostic accuracy of the endoscopic staging modalities, respectively, were EBUS, 72% (95% CI, 0.58-0.83), 88% (0.81-0.93), and 91% (0.85-0.95); EUS, 62% (0.48-0.75), 85% (0.78-0.91), and 88% (0.82-0.92); and combined EBUS/EUS, 91% (0.79-0.97), 96% (0.90-0.99), and 97% (0.93-0.99). Endosonography was diagnostic for N2/N3/M1 disease in 24 patients in whom SMS findings were negative, preventing futile thoracotomy in an additional 14% of patients.

CONCLUSIONS:  The combined EBUS/EUS procedure can replace surgical mediastinal staging in patients with potentially resectable NSCLC. Additionally, endosonography leads to improved staging compared with SMS because it allows the biopsy of LNs and metastases unattainable with SMS techniques.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01011595; URL: www.clinicaltrials.gov

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