Introduction: Confirmatory mediastinoscopy after negative endosonography findings is advised by the guidelines on patients with resectable NSCLC and suspected intrathoracic nodes on fludeoxyglucose F 18 positron emission tomography-computed tomography. Its role however is under debate owing to its limited nodal metastasis detection rate, morbidity, associated treatment delay, and unknown impact on survival.
Methods: Systematic review and meta-analysis of studies on invasive mediastinal staging in patients with (suspected) NSCLC. The Medline, Embase, and Cochrane databases were searched until September 19, 2018, without year or language restrictions. The Quality Assessment Tool for Diagnostic Accuracy Studies, version 2, was used to evaluate the risk of bias and applicability of the included studies. Rates of unforeseen N2 disease were assessed for endobronchial ultrasound and/or endoscopic ultrasound staging strategies with or without confirmatory mediastinoscopy. Additionally, the complication rates of cervical video mediastinoscopy for mediastinal staging of NSCLC were investigated.
Results: A total of 5073 articles were found, of which 42 studies or subgroups (covering a total of 3248 patients undergoing the surgical reference standard of treatment) were considered in the analysis. Random effects meta-analysis of endosonography with or without confirmatory mediastinoscopy showed rates of unforeseen N2 disease of 9.6% (95% confidence interval [CI]: 7.8%-11.7%, I = 30%) versus 9.9% (95% CI: 6.3%-15.2%, I = 73%), respectively. Random effects meta-analysis of mediastinoscopy (eight studies [1245 patients in total]) showed a complication rate of 6.0% (95% CI: 4.8%-7.5%), with laryngeal recurrent nerve palsy accounting for 2.8% (95% CI: 2.0%-4.0%).
Conclusion: The rate of unforeseen N2 disease after negative endosonography findings was similar in patients undergoing immediate lung tumor resection to those undergoing confirmatory mediastinoscopy first, at the cost of 6.0% rate of complications by mediastinoscopy.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jtho.2019.02.032 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Endobronchial ultrasound-guided transbronchial needle aspiration validated with video-assisted mediastinoscopic lymphadenectomy in the mediastinal restaging of patients with stage IIIA non-small cell lung cancer after induction therapy.
Ther Adv Respir Dis
November 2024
Pulmonology Department, Hospital Universitari Mútua Terrassa, University of Barcelona, Plaça Dr Robert 5, Terrassa, Barcelona 08221, Spain.
Article Synopsis
- This study examines the use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for restaging non-small cell lung cancer (NSCLC) after initial treatment, validated by a separate procedure called video-assisted mediastinoscopic lymphadenectomy (VAMLA).* -
- A retrospective analysis of patients showed that EBUS-TBNA has a moderate sensitivity (63.1%) but excellent specificity (100%) for identifying mediastinal disease, while VAMLA confirmed a 100% accuracy when follow-up was needed after a negative EBUS-TBNA result.* -
- The findings suggest EBUS-TBNA should be the first choice for invasive rest
Minimally Invasive with Maximal Yield: A Narrative Review of Current Practices in Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer.
J Laparoendosc Adv Surg Tech A
September 2024
Department of Surgery, George Washington University Hospital, Washington, District of Columbia, USA.
Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC.
View Article and Find Full Text PDFMediastinal Staging in Non-Small-Cell Lung Cancer: Saying Goodbye to Mediastinoscopy.
J Clin Oncol
August 2023
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Journal of Clinical Oncology, Accurate staging of the mediastinal lymph nodes in resectable non-small-cell lung cancer (NSCLC) is critically important to determine the overall stage of the tumor and guide subsequent management. The staging process typically begins with positron emission tomography (PET) or computed tomography imaging; however, imaging alone is inadequate, and tissue acquisition is required for confirmation of nodal disease. Mediastinoscopy was long considered the gold standard for staging of mediastinal lymph nodes, but, recently, endobronchial ultrasound-guided (EBUS) fine-needle aspiration (FNA) has become the standard of care.
View Article and Find Full Text PDFEndosonography With or Without Confirmatory Mediastinoscopy for Resectable Lung Cancer: A Randomized Clinical Trial.
J Clin Oncol
August 2023
Department of Surgery, Máxima MC, Veldhoven, the Netherlands.
Article Synopsis
- This study investigates whether immediate lung tumor resection is as effective as confirmatory mediastinoscopy for patients with suspected resectable non-small-cell lung cancer (NSCLC) who have negative endosonography results.
- A total of 360 patients were randomly assigned to either immediate resection or undergo mediastinoscopy first; results showed an unforeseen N2 disease rate of 8.8% for immediate resection and 7.7% for mediastinoscopy, indicating noninferiority.
- The findings suggest that patients can safely skip confirmatory mediastinoscopy without compromising outcomes, potentially streamlining treatment for those with resectable NSCLC.
Confirmatory Mediastinoscopy after Negative Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Mediastinal Staging of Lung Cancer: Systematic Review and Meta-analysis.
Ann Am Thorac Soc
September 2022
Department of Thoracic Surgery, Mutua Terrassa Hospital, Terrassa, Spain.
Current guidelines for non-small cell lung cancer (NSCLC) mediastinal staging recommend starting invasive staging with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). However, the indication to confirm a negative result of EBUS-TBNA by means of video-assisted mediastinoscopy (VAM) before resection differs in every guideline. Our aim was to evaluate the current evidence regarding the added value of confirmatory VAM after a negative EBUS-TBNA result for mediastinal staging in patients with NSCLC.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!