SESSION TITLE: Lung Cancer Diagnosis
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM
PURPOSE: Patients with NSCLC being evaluated for SBRT are typically staged non-invasively with PET/CT. Some centers have incorporated minimally invasive mediastinal staging with EBUS-TBNA as part of the standard workup due to its superior diagnostic accuracy for assessing nodal disease in patients with radiographic evidence of nodal disease. The additive benefit of EBUS-TBNA to non-invasive staging methods has not been evaluated in this particular setting. Our objective was to assess the change in nodal stage after EBUS-TBNA, when compared to clinico-radiological staging in this population.
METHODS: We reviewed the medical records of patients undergoing EBUS-TBNA for staging of NSCLC at MDACC from 2007-2013 and identified all subjects potentially eligible for SBRT, defined as i) primary tumor measuring ≤ 5 cm, and ii) N0M0 or N1M0 disease according to PET/CT. All patients were analyzed, regardless of the final treatment received. Our main outcome was the change in the N designation between PET/CT and EBUS-TBNA
RESULTS: From a total of 4,198 patient records, we identified a total of 266 eligible patients, 127 (49%) were female and majority were Caucasian (86%). Mean age was 69 (44-89). The main histological diagnoses were adenocarcinoma 51%, squamous 38%, and others 11%. Mean tumor size was 2.7 cm (0.7-5 cm), and most (76%) were peripherally located. Compared with radiographic staging, EBUS-TBNA led to stage shift in 47 out of 266 patients (18%). Out of 190 clinical N0 patients, 7 (3.7%) were found to have occult nodal disease on EBUS-TBNA. Of them, 5 were upstaged to N1 and 2 to N2. Of note, occult disease was only found in patients with tumors > 2 cm (T1B or higher). Among the 74 patients with N1 disease, 40 (54%) were downstaged to N0 after EBUS-TBNA, and therefore became SBRT eligible.
CONCLUSIONS: Incorporating EBUS-TBNA in the staging work up resulted in a change in the N designator in a substantial fraction of radiographically early stage NSCLC patients.
CLINICAL IMPLICATIONS: EBUS-TBNA was beneficial in both identifying occult nodal disease that would otherwise be left untreated with SBRT, and in expanding the pool of patients eligible for SBRT who would otherwise not have been candidates based on non-invasive staging.
DISCLOSURE: The following authors have nothing to disclose: Macarena Rodriguez Vial
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