BTOG-113A COMBINED ULTRASOUND OF THE MEDIASTINUM BY USE OF A SINGLE ULTRASOUND BRONCHOSCOPE FOR NON-SMALL CELL LUNG CANCER RESTAGING: A PROSPECTIVE STUDY

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S30-S30
• Main Authors: Szlubowski, Artur, Soja, J., Filarecka, A., Orzechowski, S., Obrochta, A., Jakubiak, M., Zieliński, M., Pankowski, J.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.113

Objectives The aim of the prospective trial was to access a diagnostic yield of the combined approach–endobronchial (EBUS) and endoscopic (EUS) ultrasound guided needle aspiration by use of a single ultrasound bronchoscope (CUSb-NA) for non-small-cell lung cancer in patients after neoadjuvant therapy. Methods In a consecutive group of NSCLC patients with pathologically confirmed N2 disease, who underwent neoadjuvant chemotherapy, CUSb-NA was performed. All negative patients underwent subsequently the transcervical extended bilateral mediastinal lymphadenectomy (TEMLA) as a confirmatory test. Results 106 patients underwent restaging CUSb-NA from January 2009 to December 2012. There were 175 mediastinal lymph node stations biopsied (stations: 1–1, 2R–5, 2L–4, 4R–33, 4L–43, 7–84, 8–5). CUSb-NA revealed metastatic lymph node involvement in 37/106 patients (34.9%). In 69 (65.1%) patients with negative or uncertain CUSb-NA, who underwent subsequent TEMLA, metastatic nodes were found in 18 patients (17.0%) and there was “minimal N2” in 11 out of them. False-positive results were found in 2 (1.9%) patients. In 7 patients CUSb-NA occurred to be false-negative in the right paratracheal stations 2R and 4R, only accessible for EBUS and in next 4 patients in station 5–not accessible for CUSb-NA, only in small nodes. A diagnostic sensitivity, specificity, accuracy, PPV and NPV of the restaging CUSb-NA was 67.3% (95% CI–58–88), 96.1% (95% CI–85–98), 81.1%, 94.9% (95% CI–87–100) and 73.1% (95% CI–68–92), respectively. No complications of CUSb-NA were observed. Conclusions CUSb-NA is a reasonable and safe technique for mediastinal restaging in NSCLC patients. After our data, in patients with negative result of the combined ultrasound guided endobronchial and endoscopic procedure, a surgical restaging of the mediastinum should be reconsidered. Disclosure All authors have declared no conflicts of interest.