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R. Burrah

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    P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P1.02-023 - The Role of Selective EBUS-TBNA Mediastinal Sampling in Early Lung Cancer (ID 542)

      09:30 - 17:00  |  Author(s): R. Burrah

      • Abstract
      • Slides

      Accurate pre-operative staging of the mediastinum in lung cancer is essential to determine the type of treatment. The commonly used investigations are CT scan, PET scan, EBUS-TBNA (Endobronchial ultrasound-guided transbronchial needle aspiration) and mediastinoscopy, and often these tests complement each other to increase the accuracy of staging. With advances in technology and increased experience, EBUS has the potential to replace mediastinoscopy to stage the mediastinum. Surgical mediastinal dissection, though commonly performed, has not been convincingly proven to have a therapeutic value. We postulate that if the mediastinum can be staged accurately with EBUS-TBNA (a low morbid procedure) then a surgical staging of the mediastinum (mediastinoscopy and / or dissection) can be avoided and therefore, avoid the morbidity associated with these procedures. We have studied the use of selective EBUS-TBNA which is sampling abnormal nodes on imaging (CT, PET scan) and compared it with the mediastinal dissection done surgically.

      This is a retrospective study of patients who underwent surgery (lobectomy/pneumonectomy + mediastinal lymphnode dissection) for early stage lung cancer (stage I/II).Patients who had negative N2 lymph nodes on EBUS-TBNA evaluation were included in the study. All patients had CT and PET scans which assisted the EBUS study. The results of EBUS-TBNA were compared with that of the surgical mediastinal lymph node dissection.

      A total of 86 patients were included in the study. EBUS-TBNA correctly staged the mediastinum in 78 patients (90.7%, negative predictive value (NPV) = 0.90). Eight patients had false negative (FN) evaluation by EBUS-TBNA. On review, two of these patients had a sampling error. Three patients had incomplete evaluation of the mediastinum. All these 3 patients had left lung cancer whose level 5 lymph nodes could not be sampled, and surgical sampling displayed these nodes to be involved with extracapsular spread. There were three other patients with FN results, and they had mediastinal nodes biopsied by EBUS which with surgical removal showed metastasis. Two of these patients had metastatic deposits < 3mm in size. We feel that diligent and systematic EBUS would have avoided the FN result in most of the above patients except for sampling of level 5 nodes which may not be technically accessible by EBUS. The NPV for right lung cancers, especially right upper lobe (NPV=0.96) was higher as compared to left sided cancers.

      This study shows that selective EBUS-TBNA mediastinal staging in early lung cancer is feasible, has an acceptable NPV and provides evidence to facilitate studies on systematic EBUS. This study draws attention thorough the identified 8 FNs to the real and potentially avoidable limitations of selective EBUS mediastinal lymphnode sampling. The accuracy of systematic EBUS evaluation should be superior to a selective study and can therefore potentially avoid a surgical staging of the mediastinum and its associated complications.

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