Endoscopic Mediastinal Staging in Lung Cancer Is Superior to “Gold Standard” Surgical Staging

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• 作者：Ilyes Berania ; MD ; Jordan Kazakov ; MD ; Mohamed Khereba ; MD ; Eric Goudie ; MD ; Pasquale Ferraro ; MD ; Vicky Thiffault ; RN ; Moishe Liberman ; MD ; PhD ; ^{moishe.liberman@umontreal.ca" class="auth_mail" title="E-mail the corresponding author}
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：101
• 期：2
• 页码：547-550
• 全文大小：102 K

文摘

The objective was to evaluate whether endobronchial ultrasonography (EBUS) or endoscopic ultrasonography (EUS) staging techniques of the mediastinum for lung cancer can change the treatment plan compared with the “gold standard” of surgical staging.

bsSec_2">Methods

bspara0015">Patients were retrospectively identified from a prospectively collected database. Endoscopic staging was compared with the “gold standard” cervical mediastinoscopy (CM). In cases where mediastinoscopy was not performed, EBUS/EUS was compared with “ideal” CM, a virtual procedure, which was assumed to have 100% rates of sensitivity and specificity.

bsSec_3">Results

bspara0020">EBUS was performed in 324 patients (99%), EUS in 295 patients (90%), and CM in 101 patients (31%); 226 patients (69%) were assumed to have undergone a virtual ideal CM and a virtual surgical mediastinal staging; 108 positive biopsies (33.0%) with endosonography had sampling of targets that were out of the scope of CM. Distant metastatic disease was diagnosed by EBUS/EUS in 7 patients (2.1%); 22 patients (6.7%) had positive targets outside the reach of the CM or virtual CM. If the 14 patients who had positive stations 5, 6, 10, and 11 are excluded (accessible with anterior mediastinotomy or extended cervical mediastinoscopy), there were 6 patients (1.8%) in whom endosonography upstaged the patient over ideal surgical mediastinal staging. In 20 patients (6.1%), ultrasound-guided biopsy made the diagnoses, which changed the treatment plan over CM and ideal CM.

bsSec_4">Conclusions

bspara0025">Combined EBUS- and EUS-guided biopsies can access more targets, including lung and distant metastasis, and thus have the potential to upstage patients compared with mediastinoscopy and change the treatment plan.