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Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study

Herbert Decaluwé, Christophe Dooms, Xavier Benoit D'Journo, Sergi Call, David Sanchez, Benedikt Haager, Roel Beelen, Volkan Kara, Thomas Klikovits, Clemens Aigner, Kurt Tournoy, Mahmood Zahin, Johnny Moons, Geoffrey Brioude, Juan Carlos Trujillo, Walter Klepetko, Akif Turna, Bernward Passlick, Laureano Molins, Ramon Rami-Porta, Pascal Thomas, Paul De Leyn
European Respiratory Journal 2017 50: 1701493; DOI: 10.1183/13993003.01493-2017
Herbert Decaluwé
Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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  • For correspondence: Herbert.decaluwe@uzleuven.be
Christophe Dooms
Dept of Pneumology, University Hospitals Leuven, Leuven, Belgium
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Xavier Benoit D'Journo
Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
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Sergi Call
Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain
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  • ORCID record for Sergi Call
David Sanchez
Dept of Thoracic Surgery, Hospital Clinic, Barcelona University, Barcelona, Spain
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Benedikt Haager
Dept of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
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Roel Beelen
Dept of Cardiovascular and Thoracic Surgery, OLV Ziekenhuis, Aalst, Belgium
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Volkan Kara
Dept of Thoracic Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
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Thomas Klikovits
Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Clemens Aigner
Dept of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany
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Kurt Tournoy
Dept of Pneumology, OLV Ziekenhuis, Aalst, Belgium
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Mahmood Zahin
Dept of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany
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Johnny Moons
Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Geoffrey Brioude
Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
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Juan Carlos Trujillo
Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain
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Walter Klepetko
Division of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Akif Turna
Dept of Thoracic Surgery, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey
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Bernward Passlick
Dept of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
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Laureano Molins
Dept of Thoracic Surgery, Hospital Clinic, Barcelona University, Barcelona, Spain
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Ramon Rami-Porta
Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Barcelona, Spain
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Pascal Thomas
Dept of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
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Paul De Leyn
Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract

A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography–computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multicentre trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAMLA).

Consecutive patients with operable and resectable (suspected) NSCLC and cN1 after PET-CT imaging underwent VAM(LA). The primary study outcome was sensitivity to detect N2 disease. Secondary endpoints were the prevalence of N2 disease, negative predictive value (NPV) and accuracy of VAM(LA).

Out of 105 patients with cN1 on imaging, 26% eventually developed N2 disease. Invasive mediastinal staging with VAM(LA) had a sensitivity of 73% to detect N2 disease. The NPV was 92% and accuracy 93%. Median number of assessed lymph node stations during VAM(LA) was 4 (IQR 3–5), and in 96%, at least three stations were assessed.

VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1 lung cancer, and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with a one in four chance of occult-positive mediastinal nodes after negative PET-CT.

Abstract

Videomediastinoscopy reaches a sensitivity of 73% detecting N2 disease in cN1 NSCLC patients; N2 prevalence is 26% http://ow.ly/VrzL30gIOWm

Footnotes

  • Clinical trial: This study is registered at ClinicalTrials.gov with identifier number NCT02222194.

  • Support statement: This study was supported by grant from Funds for Research—Flanders to Herbert Decaluwe (FWO application 40682). Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

  • Received July 22, 2017.
  • Accepted September 25, 2017.
  • Copyright ©ERS 2017
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Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study
Herbert Decaluwé, Christophe Dooms, Xavier Benoit D'Journo, Sergi Call, David Sanchez, Benedikt Haager, Roel Beelen, Volkan Kara, Thomas Klikovits, Clemens Aigner, Kurt Tournoy, Mahmood Zahin, Johnny Moons, Geoffrey Brioude, Juan Carlos Trujillo, Walter Klepetko, Akif Turna, Bernward Passlick, Laureano Molins, Ramon Rami-Porta, Pascal Thomas, Paul De Leyn
European Respiratory Journal Dec 2017, 50 (6) 1701493; DOI: 10.1183/13993003.01493-2017

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Mediastinal staging by videomediastinoscopy in clinical N1 non-small cell lung cancer: a prospective multicentre study
Herbert Decaluwé, Christophe Dooms, Xavier Benoit D'Journo, Sergi Call, David Sanchez, Benedikt Haager, Roel Beelen, Volkan Kara, Thomas Klikovits, Clemens Aigner, Kurt Tournoy, Mahmood Zahin, Johnny Moons, Geoffrey Brioude, Juan Carlos Trujillo, Walter Klepetko, Akif Turna, Bernward Passlick, Laureano Molins, Ramon Rami-Porta, Pascal Thomas, Paul De Leyn
European Respiratory Journal Dec 2017, 50 (6) 1701493; DOI: 10.1183/13993003.01493-2017
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