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Author Spotlight: Demonstrating Systematic Endobronchial Ultrasound to New Endoscopists
Published on: August 11, 2023
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LYMPH NODE UPSTAGING AFTER SURGERY IN PATIENTS WITH NEGATIVE MEDIASTINAL STAGING BY EBUS
Daniel Cabral1, Cristina Rodrigues1, Mariana Antunes1
1Thoracic Surgery Department, Hospital Pulido Valente, CHULN, Lisboa, Portugal.
Portuguese Journal of Cardiac Thoracic and Vascular Surgery
|March 25, 2022
Summary
Mediastinal staging for lung cancer requires further investigation beyond Endobronchial Ultrasound (EBUS) sampling. Cervical mediastinoscopy is crucial in only 7% of cases with negative EBUS staging, highlighting its limited but important role.
Area of Science:
- Thoracic Oncology
- Surgical Oncology
Background:
- Mediastinal staging is critical for lung cancer treatment decisions.
- Current guidelines suggest cervical mediastinoscopy may be needed after negative Endobronchial Ultrasound (EBUS) lymph node sampling if PET-CT shows increased uptake.
- This study evaluates the necessity of mediastinoscopy in such cases.
Purpose of the Study:
- To determine the rate of surgical upstaging in patients with negative mediastinal lymph node staging by EBUS.
- To assess the role and yield of cervical mediastinoscopy in these specific patient subgroup.
Main Methods:
- Retrospective database search for patients who underwent EBUS for mediastinal staging between January 2014 and August 2020.
- Analysis of 42 selected cases with negative EBUS staging.
- Review of surgical pathology results for lymph node upstaging.
Main Results:
- Surgical upstaging occurred in 11 (26%) of 42 patients (8 to N2, 3 to N1).
- Upstaging was more common in males and lower lobe tumors.
- Only 5 (12%) of upstaged patients had involvement in previously sampled EBUS stations.
Conclusions:
- Cervical mediastinoscopy would have been primarily important in only 3 (7%) of the 42 analyzed cases.
- The yield of cervical mediastinoscopy is limited in patients with negative EBUS staging.
- Further refinement of staging strategies is warranted.
