Abstract
Introduction: Guidelines recommend Endobronchial Ultrasound (EBUS) and/or Endoscopic Ultrasound (EUS) for mediastinal nodal staging of lung cancer. The benefit of the routine addition of EUS-B to EBUS is under discussion.
Aim: To investigate the added value of EUS with the EBUS scope (EUS-B) to EBUS for loco-regional mediastinal nodal staging.
Methods: Prospective, international multicentre (n=8) study in patients with (suspected) NSCLC and an indication for invasive mediastinal nodal staging. EUS-B-FNA was performed following a systematic EBUS-TBNA evaluation including routine aspiration of nodes with short axis > 8 mm. Surgical staging / nodal dissection was the reference standard for negative endosonography findings.
Results: 229 patients (mean age 65 years, 141 male) were evaluated (2013-2014). Final diagnoses were NSCLC, SCLC, benign and other in 202, 13, 11 and 3 patients, respectively. The prevalence of mediastinal (N2/3) metastases was 115/229 (50%). EUS-B had an added value for mediastinal metastases in 15 patients (7%). Additional nodal metastases were located within (n=10) and out (n=5) of reach for EBUS. Combined EBUS + EUS-B results were false negative for (N2/3) in 22 patients (10%). In 10/22 patients (45%) these nodes were located in stations 5/6/3A, beyond reach of endosonography. Sensitivity and NPV of EBUS alone vs combined EBUS+EUS-B were 77% and 81% vs 81% and 84%, respectively. Added investigational time of EUS-B ranged from 3-25 minutes.
Conclusion and implication: The routine addition of EUS-B to EBUS results in improved loco-regional staging of patients with NSCLC. Therefore, the use of EUS-B added to EBUS should be encouraged.
- Copyright ©ERS 2015