Minimally invasive strategy for mediastinal staging of patients with lung cancer

INTRODUCTION The exclusion of mediastinal involvement in patients with non-small cell lung cancer is
essential for choosing an appropriate therapy.
OBJECTIVES The aim of the study was to analyze the ability of a new minimally invasive strategy combining
positron emission tomography (PET), endobronchial ultrasound needle aspiration (EBUS-NA), and
endoscopic ultrasound needle aspiration (EUS-NA) to exclude mediastinal nodal metastases of non-small
cell lung cancer.
PATIENTS AND METHODS In a group of consecutive patients with primary non-small cell lung cancer,
the preoperative assessment of medisastinal lymph nodes using PET, EBUS-NA, and EUS-NA. Patients
in whom this minimally invasive staging protocol did not confirm mediastinal nodal metastases underwent
pulmonary resection with systematic lymph node dissection. The negative predictive values of the
combined EBUS-NA/EUS-NA as well as PET/EBUS -NA/EUS-NA were calculated.
RESULTS We analyzed data of 532 patients (367 men and 165 women; mean age, 65 years [range,
30–84 years]). Squamous carcinoma were diagnosed in 276 patients; adenocarcinoma, in 150; large cell
carcinoma, in 22; adenosquamous carcinoma, in 40; small cell carcinoma, in 4; carcinoids, in 21; and
other histological types, in 19. We performed 421 lobectomies, 55 pneumonectomies, 51 bilobectomies,
and 5 sublobar resections. In all patients, systematic lymph node dissection was performed. The mean
number of removed lymph nodes was 22. The negative predictive value of EBUS-NA/EUS-NA was 89.8%
and of PET/EBUS-NA/EUS-NA—93.2%.
CONCLUSIONS Patients with lung cancer with negative results of PET, EBUS-NA, and EUS-NA are at low
risk of mediastinal nodal metastasis. In these patients, invasive mediastinal staging may not be necessary.