Invasive mediastinal staging for resected non–small cell lung cancer in a population-based cohort

Osarogiagbon, Raymond U.; Lee, Yu-Sheng; Faris, Nicholas R.; Ray, Meredith; Ojeabulu, Philip; Smeltzer, Matthew P.

doi:10.1016/j.jtcvs.2019.04.068

Cited by 36 publications

(30 citation statements)

References 29 publications

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“…[4][5][6] Recently, one cohort study reported that proper preoperative staging was associated with survival benefits in patients with non-small cell lung cancer (NSCLC). 7 The superiority of EBUS-TBNA over radiological imaging, such as computed tomography (CT) and positron emission tomography-CT (PET-CT), has been attributed to its higher diagnostic accuracy rate (DAR). 4 Two meta-analyses reported a cumulative sensitivity and specificity of 88%-93% and 100%, respectively, for EBUS-TBNA in NSCLC staging; however, targeted LNs had a short axis diameter of at least 1 cm on CT in the majority of the included studies.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

et al. 2020

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Background Endobronchial ultrasound (EBUS) elastography assists in the differentiation of benign and malignant lymph nodes (LNs) during transbronchial needle aspiration (TBNA). However, previous studies have not compared B‐mode sonographic images (BSIs) and EBUS elastography images (EEIs) with final pathological diagnoses in radiologically normal‐sized (computed tomography [CT]‐negative) LNs. Methods Consecutive patients with CT‐negative LNs, who received EBUS‐TBNA, were retrospectively reviewed. Images of BSIs and EEIs of each LN were stored and independently evaluated. EEIs were assessed by calculating the stiffness area ratio (SAR, blue/overall areas). The receiver operating characteristic curve was used to calculate the cutoff value for the SAR. Diagnostic test parameters were evaluated for each EBUS finding. Results A total of 132 patients (149 LNs) were enrolled, and the median SAR of malignant LNs was significantly higher than that of benign LNs (0.58 vs. 0.32, P < 0.001). At the SAR cutoff of 0.41, the sensitivity, specificity, positive predictive value, negative predictive value (NPV), and diagnostic accuracy rate (DAR) of elastography were 88.2%, 80.2%, 78.9%, 89.0%, and 83.9%, respectively. The logistic regression analysis showed that elastography was the strongest predictor of malignancy (odds ratio, 18.5; 95% confidence interval [CI]: 6.48–52.6; P < 0.001). The highest NPV (96.6%) was achieved with a combination of BSIs and EEIs. Conclusions EBUS elastography predicted malignant LNs with a high DAR and NPV in CT‐negative LNs. The NPV was highest when EEIs were combined with BSIs. Therefore, the combined evaluation of CT‐negative LNs using EEIs and BSIs may help bronchoscopists perform EBUS‐TBNA more efficiently. Key points Significant findings of the study Endobronchial ultrasound elastography accurately predicted malignancy with a high diagnostic accuracy rate and negative predictive value in radiologically normal‐sized lymph nodes. The additional use of B‐mode sonographic features resulted in a higher negative predictive value. What this study adds Endobronchial ultrasound elastography can guide the accurate collection of specimens with transbronchial needle aspiration, even in radiologically normal‐sized lymph nodes. It can also readily distinguish benign and malignant lymph nodes, thus avoiding unnecessary punctures.

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Section: Introductionmentioning

confidence: 99%

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

et al. 2020

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“…Accurate staging has been reported to reduce the number of futile operations, and improve the quality of surgery and survival. 15,16 Standardized low-technology exercise testing integrated in our routine risk assessment seemed to provide an excellent estimate of the physiological capacity of these patients. 3 Third, the overall high rate of minimally invasive approaches, anatomic lung resections, R0 resections, and formal lymphadenectomies, together with a low rate of major morbidity and 90-day mortality reflects the quality of the surgery.…”

Section: Discussionmentioning

confidence: 99%

Extended resections and other special cases in lung cancer surgery: Real‐world population‐based outcomes

et al. 2020

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Background: Lung cancer invading outside a lobe centrally or peripherally, or presenting with synchronous or metachronous tumors, requires a special approach. Here, we aimed to evaluate the rate and outcomes of surgery of these patients in a medium-volume practice using real-world, population-based data. Methods: All patients (n = 269) on whom lung cancer surgery was performed in Central Finland and Ostrobothnia between January 2013 and December 2019 were included. A total of 40 patients with sleeve (n = 18) or other extended resections (n = 9), multifocal diseases (n = 14), and other operated synchronous cancers (n = 3) required an extended or otherwise special surgical approach (extended group). Short-and long-term outcomes were compared to high-risk (n = 72) and normal patient groups (n = 157). Results: The rate of extended resection was 14.9%. The rates of PET-CT (95%), invasive staging (35%), and brain imaging (42.5%) were highest in extended group compared to other groups. Extended group had larger and higher rate of stage III tumors than high-risk and normal groups. All extended group patients underwent anatomic lung resection with better lymph node yield than the other two groups, with a neoadjuvant and/or adjuvant treatment rate of 70.0%. Major complications occurred in 7.5% in the extended group, 19.4% in the high-risk group, and 6.4% in the normal group; at one year, alive and living at home rates were 88.2%, 83.3%, and 97.8%, and overall five-year survival rates 75.6%, 62.4%, and 63.9% (P = 0.287), respectively. Conclusions: After guideline-based evaluation, a significant rate of these special cases can be resected with a low complication rate and good long-term survival in real-world practice.

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“…3 Recent studies show substantial improvements with rates of mediastinoscopy without nodal tissue down to 7% to 17%. 4,5 Similar concerns apply to EBUS. EBUS is known to have diagnostic yields that are low (37%-54%) and variable across centers.…”

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confidence: 95%

Still Guideline-Discordant After All These Years

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2020

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Invasive mediastinal staging for resected non–small cell lung cancer in a population-based cohort

Cited by 36 publications

References 29 publications

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

Quantitative analysis of endobronchial ultrasound elastography in computed tomography‐negative mediastinal and hilar lymph nodes

Extended resections and other special cases in lung cancer surgery: Real‐world population‐based outcomes

Still Guideline-Discordant After All These Years

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