OBJECTIVES Recent practice guidelines recommend endosonography for patients with radiological N0 non-small cell lung cancer (NSCLC) when the primary tumors are >3 cm in diameter or centrally located. However, any role for endosonography remains debatable. We evaluated the utility of endosonography in patients with radiological N0 NSCLC based on tumor centrality, diameter and histology. MATERIALS AND METHODS Patients who underwent staging endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with or without transesophageal bronchoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA) for radiological N0 NSCLC were retrospectively investigated using prospectively collected endosonography data. The radiological N0 stage was defined by node diameter as evident on computed tomography images and 18F-FDG uptake using integrated positron emission tomography-computed tomography. RESULTS In total of 168 patients, the median size of the primary tumor was 39 mm, and 41 % of tumors were centrally located. The prevalence of occult mediastinal metastases was 11.3 % (19/168). The sensitivity of endosonography in terms of diagnosing occult mediastinal metastases was only 47 % (9/19); 6 of 10 patients with false-negative endosonography data exhibited metastases in accessible nodes. The diagnostic performance of endosonography did not differ by tumor centrality or diameter. Patients with adenocarcinoma histology showed higher prevalence of occult mediastinal metastases and higher false-negative results in endosonography compared with those with non-adenocarcinoma histology. CONCLUSION Not all patients with radiological N0 NSCLC benefit from endosonography, given the low prevalence of occult mediastinal metastases and the poor sensitivity of endosonography in this population. The strategy of invasive mediastinal staging needs to be tailored considering the histology of the tumor in this population.

中文翻译：

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内窥镜检查在放射性N0疾病患者非小细胞肺癌纵隔分期中的应用。

目的原发性肿瘤的直径大于3 cm或位于中心时，放射学N0非小细胞肺癌（NSCLC）患者应推荐超声内镜检查。但是，超声内镜的任何作用仍有待商bat。我们根据肿瘤的中心性，直径和组织学评估了内镜在放射N0 NSCLC患者中的实用性。材料与方法回顾性分析采用前瞻性收集的超声内镜检查资料，对接受或不经食管支气管镜超声引导下细支气管穿刺术（EUS-B-FNA）进行分期支气管内超声引导下经支气管针穿刺术（EBUS-TBNA）的患者进行回顾性研究。放射学N0阶段由在计算机断层扫描图像上明显可见的节点直径和使用集成正电子发射断层扫描-计算机断层扫描的18F-FDG摄取来定义。结果总共168例患者中，原发性肿瘤的中位大小为39 mm，41％的肿瘤位于中心。隐匿性纵隔转移的患病率为11.3％（19/168）。内镜检查对隐匿性纵隔转移的诊断敏感性仅为47％（9/19）。10例错误阴性内窥镜检查数据中有6例在可触及结节内出现转移。内镜检查的诊断性能在肿瘤中心或直径方面没有差异。与非腺癌组织学相比，腺癌组织学检查的患者在超声检查中隐匿性纵隔转移的发生率更高，内镜检查的假阴性结果也更高。结论鉴于隐匿性纵隔转移的患病率较低，并且该人群的超声检查敏感性较低，因此并非所有放射性N0 NSCLC放射治疗的患者都受益于超声检查。考虑到该人群肿瘤的组织学，需要调整侵入性纵隔分期策略。