0
Original Research: Lung Cancer |

Endosonography for Mediastinal Nodal Staging of Clinical N1 Non-small Cell Lung CancerEndosonography for Mediastinal Nodal Staging: A Prospective Multicenter Study

Christophe Dooms, MD, PhD; Kurt G. Tournoy, PhD; Olga Schuurbiers, PhD; Herbert Decaluwe, MD; Frédéric De Ryck, MD; Ad Verhagen, MD; Roel Beelen, MD; Erik van der Heijden, PhD; Paul De Leyn, PhD
Author and Funding Information

From the Respiratory Division (Dr Dooms), and the Department of Thoracic Surgery (Drs Decaluwe and De Leyn), University Hospitals Leuven, Leuven, Belgium; the Department of Pneumology (Dr Tournoy) and the Department of Thoracic Surgery (Dr De Ryck), University Hospital Ghent, Ghent, Belgium; the Department of Pneumology (Dr Tournoy) and the Department of Cardiothoracic Surgery (Dr Beelen), OLV Ziekenhuis Aalst, Aalst, Belgium; the Department of Pulmonary Disease (Drs Schuurbiers and van der Heijden) and the Department of Cardiothoracic Surgery (Dr Verhagen), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.

CORRESPONDENCE TO: Christophe Dooms, MD, PhD, Respiratory Division, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium; e-mail: christophe.dooms@uzleuven.be


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.


Chest. 2015;147(1):209-215. doi:10.1378/chest.14-0534
Text Size: A A A
Published online

BACKGROUND:  Patients with clinical N1 (cN1) lung cancer based on imaging are at risk for malignant mediastinal nodal involvement (N2 disease). Endosonography with a needle technique is suggested over surgical staging as a best first test for preoperative invasive mediastinal staging. The addition of a confirmatory mediastinoscopy seems questionable in patients with a normal mediastinum on imaging. This prospective multicenter trial investigated the sensitivity of preoperative linear endosonography and mediastinoscopy for mediastinal nodal staging of cN1 lung cancer.

METHODS:  Consecutive patients with operable and resectable cN1 non-small cell lung cancer underwent a lobe-specific mediastinal nodal staging by endosonography. The primary study outcome was sensitivity to detect N2 disease. The secondary end points were the prevalence of N2 disease, the negative predictive value (NPV) of both endosonography and endosonography with confirmatory mediastinoscopy, and the number of patients needed to detect one additional N2 disease with mediastinoscopy.

RESULTS:  Of the 100 patients with cN1 on imaging, 24 patients were diagnosed with N2 disease. Invasive mediastinal nodal staging with endosonography alone has a sensitivity of 38%, which can be increased to 73% by adding a mediastinoscopy. NPV was 81% and 91%, respectively. Ten mediastinoscopies are needed to detect one additional N2 disease missed by endosonography.

CONCLUSIONS:  Endosonography alone has an unsatisfactory sensitivity to detect mediastinal nodal metastasis in cN1 lung cancer, and the addition of a confirmatory mediastinoscopy is of added value.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01456429; URL: www.clinicaltrials.gov

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543