Systematic and combined endosonographic staging of lung cancer (SCORE study). Issue 2 (7th February 2019)

• Record Type: Journal Article
• Authors: Crombag, Laurence M.M.; Dooms, Christophe; Stigt, Jos A.; Tournoy, Kurt G.; Schuurbiers, Olga C.J.; Ninaber, Maarten K.; Buikhuisen, Wieneke A.; Hashemi, Sayed M.S.; Bonta, Peter I.; Korevaar, Daniël A.; Annema, Jouke T.
• Is Part Of: European respiratory journal. Volume 53:Issue 2(2019)
• Publication Date: 2019-02-07
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.00800-2018
• Languages: English
• ISSNs: 0903-1936

Abstract

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. In lung cancer patients, a systematic endobronchial ultrasound (EBUS) combined with an oesophageal investigation using the same EBUS bronchoscope (EUS-B ) increases the sensitivity for mediastinal nodal staging by 9% compared to a targeted EBUS procedure http://ow.ly/aPqF30mJ15q