Endosonography for mediastinal nodal staging of clinical n1 non-small cell lung cancer: A prospective multicenter study
Menée sur 100 patients atteints d'un cancer du poumon non à petites cellules de stade cN1 et résécable, cette étude multicentrique évalue la performance d'une échoendoscopie linéaire pré-opératoire, avec ou sans médiastinoscopie, pour détecter des métastases ganglionnaires du médiastin
Background : Patients with clinical N1 (cN1) lung cancer based on imaging are at risk for malignant mediastinal nodal involvement (N2-disease). Endosonography with a needle technique is suggested over surgical staging as a best first test for preoperative invasive mediastinal staging. The addition of a confirmatory mediastinoscopy seems questionable in patients with a normal mediastinum on imaging. This prospective multicenter trial investigated the sensitivity of preoperative linear endosonography and mediastinoscopy for mediastinal nodal staging of cN1 lung cancer.
Methods : Consecutive patients with operable and resectable cN1 non-small cell lung cancer underwent a lobe-specific mediastinal nodal staging by endosonography. The primary study outcome was sensitivity to detect N2-disease. The secondary endpoints were the prevalence of N2-disease, the negative predictive value (NPV) of both endosonography and endosonography with confirmatory mediastinoscopy, and the number of patients needed to detect one additional N2-disease with mediastinoscopy.
Results : Of the 100 patients with cN1 on imaging, 24 patients were diagnosed with N2-disease. Invasive mediastinal nodal staging with endosonography alone has a sensitivity of 38%, which can be increased to 73% by adding a mediastinoscopy. Its NPV was 81% and 91%, respectively. Ten mediastinoscopies are needed to detect one additional N2-disease missed by endosonography.
Conclusions : Endosonography alone has an unsatisfactory sensitivity to detect mediastinal nodal metastasis in cN1 lung cancer, and the addition of a confirmatory mediastinoscopy is of added value. [clinicaltrials.gov NCT01456429]
Chest , résumé, 2013