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Virendra Kumar Tiwari



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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-03 - Is It Time to Replace Cervical Mediastinoscopy with EBUS-FNAC in Invasive Mediastinal Staging for NSCLC? (ID 2628)

      10:15 - 18:15  |  Presenting Author(s): Virendra Kumar Tiwari

      • Abstract
      • Slides

      Background

      Background: Cervical mediastinoscopy is considered the gold standard for mediastinal staging in NSCLC. However, the morbidity of this procedure is not inconsiderable and EBUS+/-EUS with guided FNAC is rapidly evolving as a replacement for mediastinoscopy.

      Method

      Aim: To evaluate EBUS-FNAC, in invasive mediastinal staging and assess the incremental value of mediastinoscopy.

      Methods: Retrospective analysis of a prospectively maintained database of patients who underwent EBUS followed by mediastinoscopy and/or surgery within a month for potentially resectable NSCLC from February 2017 to March 2019. Lymph nodes in stations 2 and 4 bilaterally and 7 were sampled, if size 5mm or more/met radiological criteria on ultrasound. Patients with negative EBUS underwent mediastinoscopy and surgery depending on the results. Data regarding PET CECT features, sampling, cytology and final histopathology was analysed.

      Result

      During the study period, 126 patients underwent EBUS for staging. Thirty-eight patients had positive mediastinal nodes, 34 with N2 and 4 with N3 disease. Eighty-eight patients were staged as N0 on EBUS, of which 15 received definitive chemoradiotherapy and 8 patients had progression of disease or were lost to follow up before definitive treatment. Sixtyfive EBUS negative patients underwent either mediastinoscopy followed by lung resection(56) or upfront lung resection with systematic mediastinal lymph node dissection(9). Nine of these patients (65) had N2 disease, 5 detected on mediastinoscopy and 4 detected on surgery (three positive in stations not accessible by mediastinoscopy or EBUS and one in a patient who could not undergo mediastinoscopy). The 5 additional N2 cases detected by mediastinoscopy had sub centimetre lymph nodes with SUV < 3, but had undergone adequate sampling(median-3 passes) on EBUS.

      Conclusion

      Presence of metastatic disease in sub centimetre mediastinal lymph nodes with low SUV cannot be excluded by imaging and this may be critical in this era of multimodality management. The sensitivity of EBUS although excellent is further augmented by mediastinoscopy and it remains an integral part of mediastinal staging.

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