Systematic and combined endosonographic staging of lung cancer (SCORE study).
Laurence M M CrombagChristophe DoomsJos A StigtKurt G TournoyOlga C J SchuurbiersMaarten K NinaberWieneke A BuikhuisenSayed M S HashemiPeter I BontaDaniël A KorevaarJouke T AnnemaPublished in: The European respiratory journal (2019)
Guidelines recommend endosonography for mediastinal nodal staging in patients with resectable nonsmall cell lung cancer (NSCLC). We hypothesise that a systematic endobronchial ultrasound (EBUS) evaluation combined with an oesophageal investigation using the same EBUS bronchoscope (EUS-B) improves mediastinal nodal staging versus the current practice of targeted positron emission tomography (PET)-computed tomography (CT)-guided EBUS staging alone.A prospective, multicentre, international study (NCT02014324) was conducted in consecutive patients with (suspected) resectable NSCLC. After PET-CT, patients underwent systematic EBUS and EUS-B. Node(s) suspicious on CT, PET, EBUS and/or EUS-B imaging and station 4R, 4L and 7 (short axis ≥8 mm) were sampled. For patients without N2/N3 disease determined on endosonography, surgical-pathological staging was the reference standard.229 patients were included in this study. The prevalence of N2/N3 disease was 103 out of 229 patients (45%). A PET-CT-guided targeted approach by EBUS identified 75 patients with N2/N3 disease (sensitivity 73%, 95% CI 63-81%; negative predictive value (NPV) 81%, 95% CI 74-87%). Four additional patients with N2/N3 disease were found by systematic EBUS (sensitivity 77%, 95% CI 67-84%; NPV 84%, 95% CI 76-89%) and five more by EUS-B (84 patients total; sensitivity 82%, 95% CI 72-88%; NPV 87%, 95% CI 80-91%). Additional clinical relevant staging information was obtained in 23 out of 229 patients (10%).Systematic EBUS followed by EUS-B increased sensitivity for the detection of N2/N3 disease by 9% compared to PET-CT-targeted EBUS alone.
Keyphrases
- pet ct
- positron emission tomography
- computed tomography
- end stage renal disease
- lymph node
- ejection fraction
- newly diagnosed
- chronic kidney disease
- prognostic factors
- small cell lung cancer
- stem cells
- magnetic resonance imaging
- healthcare
- peritoneal dialysis
- squamous cell carcinoma
- mesenchymal stem cells
- risk factors
- photodynamic therapy
- mass spectrometry
- cross sectional
- sensitive detection
- loop mediated isothermal amplification