Mark Krasnik, Armin Ernst, Ralf Eberhardt, K. Yasufuku, Felix Herth; Thoracic and Cardiovascular Surgery, Gentofte University Hospital, Copenhagen, Denmark
Objective: Protocols using indction chemotherapy for advanced lung cancer are more frequently used with the hope that surgery can be performed after the cancer is downstaged. The current restaging modalities either have a low diagnostic accuracy (computed tomography) or can be technically difficult (Re-, mediastinoscopy). Endobronchial ultrasound guided TBNA is an excellent tool for mediastinal lymph node staging and may have a role in restaging also.Methods: Patients with NSCLC and proven ipsilateral or subcarinal lymph node metastases (N2 disease, 3A disease stage) who had been treated with induction chemotherapy and showing at least stable disease or partial response on CT imaging underwent mediastinal restaging by EBUS-TBNA. This was followed by surgical resection of the tumour with lymph node dissection
Results: 83 Patients (54 male, 29 female, mean age 55,6 y.) had either a partial response (n=44) or stable disease (n=39) based on sequential CT scans of the thorax. Overall 143 nodes in N2 poaition were punctured, in 129 (90 %) lymphocells were seen in the smears. The sensitivity, specificity and diagnostic accuracy of EBUS-TBNA per patient in restaging mediastinal LN were 70, 100 and 75%, respectively. EBUS-TBNA was performed in an ambulatory setting. No complications occurred.
Conclusion: EBUS-TBNA is an accurate, safe and minimally invasive diagnostic technique for the restaging of mediastinal lymph nodes after induction therapy in NSCLC. It's routine use for this purpose should be considered.
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