Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer
Sang-Won Um, Hong Kwan Kim, Sin-Ho Jung, Joungho Han, Kyung Jong Lee, Hye Yun Park, Yong Soo Choi, Young Mog Shim, Myung-Ju Ahn, Keunchil Park, Yong Chan Ahn, Joon Young Choi, Kyung Soo Lee, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Jhingook Kim, Hojoong Kim, Sang-Won Um, Hong Kwan Kim, Sin-Ho Jung, Joungho Han, Kyung Jong Lee, Hye Yun Park, Yong Soo Choi, Young Mog Shim, Myung-Ju Ahn, Keunchil Park, Yong Chan Ahn, Joon Young Choi, Kyung Soo Lee, Gee Young Suh, Man Pyo Chung, O Jung Kwon, Jhingook Kim, Hojoong Kim
Abstract
Introduction: Correct mediastinal staging is critical for determination of the most appropriate management strategy in patients with non-small-cell lung cancer (NSCLC). The purpose of this study was to compare the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with that of mediastinoscopy in patients with NSCLC.
Methods: A prospective trial was conducted in a tertiary referral center in Korea. Patients with histologically proven NSCLC and suspicion for N1, N2, or N3 metastasis were enrolled. Each patient underwent EBUS-TBNA followed by mediastinoscopy. Surgical resection and complete lymph node dissection were conducted in patients for whom no evidence of mediastinal metastasis was apparent after mediastinoscopy.
Results: In total, 138 patients underwent EBUS-TBNA and 127 completed both EBUS-TBNA and mediastinoscopy. N2/N3 disease was confirmed in 59.1% of the patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) of EBUS-TBNA on a per-person analysis were 88.0%, 100%, 92.9%, 100%, and 85.2%, respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and NPV of mediastinoscopy on a per-person analysis were 81.3%, 100%, 89.0%, 100%, and 78.8%, respectively. Significant differences in the sensitivity, accuracy, and NPV were evident between EBUS-TBNA and mediastinoscopy (p < 0.005).
Conclusions: EBUS-TBNA was superior to mediastinoscopy in terms of its diagnostic performance for mediastinal staging of cN1-3 NSCLC. Because EBUS-TBNA is both less invasive and affords superior diagnostic sensitivity, it should be the first-line procedure performed in patients with NSCLC.
Trial registration: ClinicalTrials.gov NCT01079520.
Source: PubMed