Endosonographic mediastinal lymph node staging of lung cancer
Mené sur 166 patients atteints d'un cancer du poumon non à petites cellules ou présentant des lésions pulmonaires suspectes, cet essai évalue, par rapport aux techniques chirurgicales et du point de vue de la sensibilité, de la valeur prédictive négative et de la précision diagnostique, l'intérêt d'une échographie endobronchique et d'une échographie endoscopique, combinées ou non, pour la stadification ganglionnaire médiastinale de la maladie
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 to SMS. Each subject 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 to SMS (gold standard) and in patients with negative LN staging, to LN sampling at pulmonary resection.
Results: EBUS, EUS, 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% (53/166). The sensitivity, negative predictive value and diagnostic accuracy of the endoscopic staging modalities were: EBUS - 72% (95% confidence interval, 0.58-0.83), 88% (0.81-0.93), 91% (0.85-0.95); EUS - 62% (0.48-0.75), 85% (0.78-0.91), 88% (0.82-0.92); and combined EBUS-EUS - 91% (0.79-0.97), 96% (0.90-0.99), 97% (0.93-0.99). Endosonography was able to diagnose N2/N3/M1 disease in 24 patients in whom SMS was 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 to SMS due to its ability to biopsy lymph nodes and metastases unattainable with SMS techniques. (Funded by the Canadian Foundation for Innovation, the Society of University Surgeons, and the Fonds de Recherche en Santé du Québec).
CHEST Journal , résumé, 2013