Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer.

Journal Article (Clinical Trial;Journal Article)

INTRODUCTION: Correct mediastinal staging is critical for determination of the most appropriate management strategy in patients with non-small-cell lung cancer (NSCLC). The purpose of this study was to compare the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with that of mediastinoscopy in patients with NSCLC. METHODS: A prospective trial was conducted in a tertiary referral center in Korea. Patients with histologically proven NSCLC and suspicion for N1, N2, or N3 metastasis were enrolled. Each patient underwent EBUS-TBNA followed by mediastinoscopy. Surgical resection and complete lymph node dissection were conducted in patients for whom no evidence of mediastinal metastasis was apparent after mediastinoscopy. RESULTS: In total, 138 patients underwent EBUS-TBNA and 127 completed both EBUS-TBNA and mediastinoscopy. N2/N3 disease was confirmed in 59.1% of the patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) of EBUS-TBNA on a per-person analysis were 88.0%, 100%, 92.9%, 100%, and 85.2%, respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and NPV of mediastinoscopy on a per-person analysis were 81.3%, 100%, 89.0%, 100%, and 78.8%, respectively. Significant differences in the sensitivity, accuracy, and NPV were evident between EBUS-TBNA and mediastinoscopy (p < 0.005). CONCLUSIONS: EBUS-TBNA was superior to mediastinoscopy in terms of its diagnostic performance for mediastinal staging of cN1-3 NSCLC. Because EBUS-TBNA is both less invasive and affords superior diagnostic sensitivity, it should be the first-line procedure performed in patients with NSCLC.

Full Text

Duke Authors

Cited Authors

  • Um, S-W; Kim, HK; Jung, S-H; Han, J; Lee, KJ; Park, HY; Choi, YS; Shim, YM; Ahn, M-J; Park, K; Ahn, YC; Choi, JY; Lee, KS; Suh, GY; Chung, MP; Kwon, OJ; Kim, J; Kim, H

Published Date

  • February 2015

Published In

Volume / Issue

  • 10 / 2

Start / End Page

  • 331 - 337

PubMed ID

  • 25611227

Electronic International Standard Serial Number (EISSN)

  • 1556-1380

Digital Object Identifier (DOI)

  • 10.1097/JTO.0000000000000388


  • eng

Conference Location

  • United States