Endobronchial ultrasound-guided transbronchial needle aspiration in the nodal staging of stereotactic ablative body radiotherapy patients
Date
2017
Type:
Artículo
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6
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Journal Title
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Volume Title
Publisher
Elsevier
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Abstract
BACKGROUND:
Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic ablative body radiotherapy (SABR) are typically staged noninvasively with positron emission tomography/computed tomography (PET/CT). Incorporating endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) into the staging workup of these patients has not been evaluated. Our primary objective was to compare the performance of PET/CT with EBUS-TBNA for intrathoracic nodal assessment among SABR-eligible patients.
METHODS:
This was a retrospective study consisting of two parts. First, we assessed the concordance for nodal metastasis of PET/CT and EBUS-TBNA. Second, we evaluated clinical outcomes among patients who underwent SABR with and without a prior EBUS-TBNA.
RESULTS:
We identified 246 eligible patients. Compared with PET/CT, EBUS-TBNA led to a stage shift in 48 of 246 patients (19%). Of 174 N0 patients by PET/CT, 6 (3.4%) had nodal metastasis on EBUS-TBNA. Among 72 clinical N1 patients, 36 (50%) were downstaged to N0 after EBUS-TBNA, therefore becoming eligible for SABR. Concordance between PET/CT and EBUS-TBNA for nodal metastasis was 83% (κ = 0.53). Clinical outcomes of patients who underwent SABR with or without a prior EBUS-TBNA did not differ significantly.
CONCLUSIONS:
Concordance of PET/CT and EBUS-TBNA for nodal disease was only moderate. Incorporating EBUS-TBNA into the staging workup was beneficial in identifying occult nodal metastasis that would otherwise be left untreated with SABR and in expanding the pool of potentially SABR-eligible patients.
Description
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Citation
Vial MR, Khan KA, O'Connell O, Peng SA, Gomez DR, Chang JY, Rice DC, Mehran R, Jimenez CJ, Grosu HB, Ost DE, Eapen GA. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Nodal Staging of Stereotactic Ablative Body Radiotherapy Patients. Ann Thorac Surg. 2017 May;103(5):1600-1605
Keywords
Carcinoma, Non-Small-Cell Lung, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Lung Neoplasms, Lymph Nodes, Neoplasm Staging, Radiosurgery