Vial Macarena R, Khan Kashif A, O'Connell Oisin, Peng S Andrew, Gomez Daniel R, Chang Joe Y, Rice David C, Mehran Reza, Jimenez Carlos J, Grosu Horiana B, Ost David E, Eapen George A
Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
Department of Respiratory Medicine, Cork University Hospital/University College Cork, Ireland.
Ann Thorac Surg. 2017 May;103(5):1600-1605. doi: 10.1016/j.athoracsur.2016.09.106. Epub 2016 Dec 24.
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.
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.
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.
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.
接受立体定向体部放射治疗（SABR）评估的非小细胞肺癌（NSCLC）患者通常采用正电子发射断层扫描/计算机断层扫描（PET/CT）进行非侵入性分期。将支气管内超声引导下经支气管针吸活检（EBUS-TBNA）纳入这些患者的分期检查尚未得到评估。我们的主要目的是比较PET/CT与EBUS-TBNA在适合SABR的患者中进行胸内淋巴结评估的性能。
这是一项回顾性研究，包括两个部分。首先，我们评估了PET/CT和EBUS-TBNA对淋巴结转移的一致性。其次，我们评估了接受或未接受过EBUS-TBNA的SABR患者的临床结局。
我们确定了246例符合条件的患者。与PET/CT相比，EBUS-TBNA导致246例患者中的48例（19%）分期改变。在PET/CT检查为N0的174例患者中，6例（3.4%）经EBUS-TBNA检查发现有淋巴结转移。在72例临床N1患者中，36例（50%）经EBUS-TBNA检查后分期降为N0，因此符合SABR治疗条件。PET/CT与EBUS-TBNA对淋巴结转移的一致性为83%（κ=0.53）。接受或未接受过EBUS-TBNA的SABR患者的临床结局无显著差异。
PET/CT与EBUS-TBNA对淋巴结疾病的一致性仅为中等。将EBUS-TBNA纳入分期检查有助于识别隐匿性淋巴结转移，否则这些转移灶将无法接受SABR治疗，并且有助于扩大潜在符合SABR治疗条件的患者群体。
