Systematic Compared With Targeted Staging With Endobronchial Ultrasound in Patients With Lung Cancer

Sanz-Santos, José; Serra, Pere; Torky, Mohamed; Andreo, Felipe; Centeno, Carmen; Mendiluce, Leire; Martínez-Barenys, Carlos; Castro, Pedro López de; Ruiz-Manzano, Juan

doi:10.1016/j.athoracsur.2018.02.088

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…This has been shown for endobronchial ultrasound guided biopsy (EBUS-TBNA) for the staging of lung cancer. When comparing a systematic approach to a targeted, the former resulted in a higher diagnostic yield (30). Inspection of all segments is important as bronchoscopy can reveal endobronchial tumors that are not visible with computer tomography (31) and in patients not suspected for lung cancer (18).…”

Section: Discussionmentioning

confidence: 99%

Using structured progress to measure competence in flexible bronchoscopy

Cold¹,

Svendsen²,

Bødtger³

et al. 2020

J Thorac Dis

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Background: Flexible bronchoscopy is a core invasive procedure in pulmonary medicine and training in the procedure is mandatory. Diagnostic completeness and procedure time have been identified as useful measures of competence. No outcome measures have been developed regarding navigational path in bronchoscopy to assess whether the bronchial segments have been identified in an arbitrary or structured order. We investigated whether a new outcome measure for structured progression could be used to assess competency in flexible bronchoscopy. Methods:The study was designed as a prospective comparative study. Twelve novices, eleven intermediates, and ten expert bronchoscopy operators completed three full bronchoscopies in a simulated setting on a phantom. The following outcome measures were collected through a checklist evaluation by a trained rater: Diagnostic Completeness as amount of visualized bronchial segments, Structured Progress between the bronchial segments in ascending order, and average intersegmental time (AIT). Results: The ability to follow a structured ascending path through the bronchial tree correlated with a higher amount of identified bronchial segments (Pearson's correlation, r=0.62, P<0.001) and a lower AIT (Pearson's correlation, r=−0.52, P<0.001).Conclusions: Operators should advance through the bronchial tree in a structured ascending order to ensure systematic progress with the highest level of diagnostic yield and the lowest procedure time. Structured progression is a useful measure to evaluate competency in flexible bronchoscopy.

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Section: Discussionmentioning

confidence: 99%

Using structured progress to measure competence in flexible bronchoscopy

Cold¹,

Svendsen²,

Bødtger³

et al. 2020

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…In patients with clinical N2 NSCLC, S anz- S antos et al . [11] reported that systematic EBUS-TBNA provided additional relevant staging information in 13% of cases. In a recent study by V ial et al .…”

Section: Discussionmentioning

confidence: 99%

Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer

et al. 2019

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ObjectivesPatients suitable for radical chemoradiotherapy for lung cancer routinely have radiotherapy (planning) volumes based on positron emission tomography (PET)-computed tomography (CT) imaging alone. Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) can identify PET-occult malignancy and benign PET-avid regions. We investigated the impact of EBUS-TBNA on curative-intent radiotherapy in non-small cell lung cancer (NSCLC).MethodsA prospective multicentre trial was undertaken, investigating the impact of systematic EBUS-TBNA in addition to PET-CT for patients considered for radical chemoradiotherapy with NSCLC. A subset analysis of patients with discordant findings between PET-CT and EBUS-TBNA was performed. Radiotherapy plans investigated tumour coverage and dose to critical organs at risk (OARs) using PET-CT alone in comparison to PET-CT and EBUS-TBNA.ResultsOf 30 patients enrolled, 10 had discordant findings between PET-CT and EBUS-TBNA. EBUS-TBNA-derived plans allowed for reduction in dose to OARs in patients downstaged by EBUS-TBNA, and reduced the risk of geographic miss in treating PET-occult disease in four patients where EBUS-TBNA identified malignant involvement of PET-negative lymphadenopathy. With the addition of EBUS-TBNA to radiotherapy planning, reductions were noted of 5.7%, 3.7% and 12.5% for the risks of symptomatic pneumonitis, mean heart dose and mean oesophageal dose, respectively.ConclusionsThis study demonstrates for the first time that systematic EBUS-TBNA prior to radical-intent radiotherapy significantly improves coverage of subclinical disease through detection of PET-occult metastases. Identification of false-positive lymph node involvement in highly selected cases may reduce radiation dose to critical structures, and risk of organ toxicity.

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“…A retrospective study in 93 patients reported on systematic nodal sampling in EBUS and concluded that routinely sampling more than two mediastinal stations may improve staging [24]. A recent single-centre retrospective study reported a 13% increase in important clinical information by systematic EBUS sampling compared to targeted EBUS [25]. We also found that systematic evaluation including routine sampling of (at least) stations 4R, 7 and 4L, if the short axis ⩾8 mm, increased sensitivity for nodal staging compared to PET-CT-guided targeted EBUS alone.…”

Section: Discussionmentioning

confidence: 99%

Systematic and combined endosonographic staging of lung cancer (SCORE study)

et al. 2019

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Guidelines recommend endosonography for mediastinal nodal staging in patients with resectable nonsmall cell lung cancer (NSCLC). We hypothesise that a systematic endobronchial ultrasound (EBUS) evaluation combined with an oesophageal investigation using the same EBUS bronchoscope (EUS-B) improves mediastinal nodal stagingversusthe current practice of targeted positron emission tomography (PET)-computed tomography (CT)-guided EBUS staging alone.A prospective, multicentre, international study (NCT02014324) was conducted in consecutive patients with (suspected) resectable NSCLC. After PET-CT, patients underwent systematic EBUS and EUS-B. Node(s) suspicious on CT, PET, EBUS and/or EUS-B imaging and station 4R, 4L and 7 (short axis ≥8 mm) were sampled. For patients without N2/N3 disease determined on endosonography, surgical-pathological staging was the reference standard.229 patients were included in this study. The prevalence of N2/N3 disease was 103 out of 229 patients (45%). A PET-CT-guided targeted approach by EBUS identified 75 patients with N2/N3 disease (sensitivity 73%, 95% CI 63–81%; negative predictive value (NPV) 81%, 95% CI 74–87%). Four additional patients with N2/N3 disease were found by systematic EBUS (sensitivity 77%, 95% CI 67–84%; NPV 84%, 95% CI 76–89%) and five more by EUS-B (84 patients total; sensitivity 82%, 95% CI 72–88%; NPV 87%, 95% CI 80–91%). Additional clinical relevant staging information was obtained in 23 out of 229 patients (10%).Systematic EBUS followed by EUS-B increased sensitivity for the detection of N2/N3 disease by 9% compared to PET-CT-targeted EBUS alone.

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Systematic Compared With Targeted Staging With Endobronchial Ultrasound in Patients With Lung Cancer

Abstract: In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.

Cited by 20 publications

References 24 publications

Using structured progress to measure competence in flexible bronchoscopy

Using structured progress to measure competence in flexible bronchoscopy

Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer

Systematic and combined endosonographic staging of lung cancer (SCORE study)

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