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Is it necessary to sample the contralateral nodal stations by EBUS-TBNA in patients with lung cancer and clinical N0 / N1 on PET-CT?
Lung Cancer ( IF 5.3 ) Pub Date : 2020-01-13 , DOI: 10.1016/j.lungcan.2020.01.014
Pere Serra 1 , Carmen Centeno 1 , José Sanz-Santos 2 , Mohamed Torky 3 , Sonia Baeza 3 , Leire Mendiluce 3 , Carlos Martínez-Barenys 4 , Pedro López de Castro 4 , Jorge Abad 3 , Antoni Rosell 1 , Felipe Andreo 1
Affiliation  

OBJECTIVES Systematic mediastinal staging (sampling all visible nodes measuring ≥ 5 mm from N3 station to N1, regardless of PET/CT (positron emission tomography/computed tomography) by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a decisive step in patients with non-small cell lung cancer (NSCLC). We analyzed the prevalence of N3 disease and the utility of systematic staging in the subgroup of patients who underwent EBUS-TBNA staging without showing mediastinal lesions on the PET/CT (N0/N1). MATERIAL AND METHODS We conducted a retrospective analysis of a prospectively collected database that included 174 patients with a final diagnosis of NSCLC, with N0/N1 disease on PET/CT who underwent a systematic EBUS-TBNA staging. RESULTS 174 consecutive patients were included. Systematic EBUS-TBNA detected N2 mediastinal involvement in 21 (12 %) cases, and no cases of N3 disease were detected (neither hilar nor mediastinal). Of the remaining 153 patients N0/N1 EBUS-TBNA, 122 underwent lung resection that revealed 4 cases of N2 disease while 117 were confirmed to be N0/N1. Thirty-three patients with N0/1 disease after EBUS-TBNA did not undergo surgery and were excluded for the NPV calculation. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy of systematic EBUS was 84 %, 100 %, 96.7 %, 100 % and 97 % respectively. CONCLUSION Systematic EBUS-TBNA is a very accurate method for lymph node staging in patients with NSCLC without mediastinal involvement on PET/CT. Pending more studies, the absence of contralateral hilar nodal involvement in our series, questions the need for a contralateral hilar sampling in this subgroup of patients.

中文翻译:

在PET-CT上有临床N0 / N1的肺癌患者中,是否需要通过EBUS-TBNA对侧结节采样?

系统性EBUS-TBNA在21例(12%)病例中检测到N2纵隔受累,未检出N3疾病病例(既无肺门也不纵隔)。在剩余的153例N0 / N1 EBUS-TBNA患者中,有122例接受了肺切除术,发现4例N2疾病,而117例被确认为N0 / N1。EBUS-TBNA术后有33例N0 / 1疾病患者未接受手术,因此被排除在NPV计算范围之外。系统性EBUS的敏感性,特异性,阴性预测值(NPV),阳性预测值(PPV)和总体准确性分别为84%,100%,96.7%,100%和97%。结论系统的EBUS-TBNA是一种非常准确的方法,可用于无纵隔PET / CT介入的NSCLC患者的淋巴结分期。在进行更多研究之前,我们的系列中没有对侧肺门淋巴结转移,
更新日期:2020-01-13
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