Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands.
Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
Lung Cancer. 2019 Aug;134:52-58. doi: 10.1016/j.lungcan.2019.05.031. Epub 2019 May 30.
Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy.
We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline.
330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p < .01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p < .01). Endosonography procedures were performed 'systematically' in 21% of patients (57/277) with significant variability among centres (range 0-56%; p < .01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy.
Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.
欧洲指南推荐对非小细胞肺癌（NSCLC）患者进行初始内镜超声（endosonography）和确认性纵隔镜检查的纵隔淋巴结分期。我们评估了纵隔分期的指南遵循情况、是否系统地进行了分期程序以及在进行内镜超声检查伴或不伴确认性纵隔镜检查后，未预见的 N2 率。
我们对 2015 年无远处转移、有纵隔分期指征且为手术候选者的 NSCLC 患者进行了一项多中心（n=6）回顾性分析。所有接受 EBUS、EUS 和/或纵隔镜检查的患者均被纳入。外科淋巴结清扫术是参考标准。指南的依从性基于 2014 年 ESTS 指南。
330 例连续患者（平均年龄 69 岁；61%为男性）被纳入。N2/N3 疾病的总体患病率为 42%。初始纵隔分期通过内镜超声检查进行，占 84%（277/330；中心间范围为 71%-100%；p<.01）。在肿瘤阴性内镜超声检查的患者中，有 40%进行了确认性纵隔镜检查（61/154；中心间范围为 10%-73%；p<.01）。277 例患者中有 21%（57/277）进行了内镜超声检查“系统”检查，中心间存在显著差异（范围为 0-56%；p<.01）。在阴性内镜超声检查后进行肺叶特异性淋巴结清扫术的情况下，未预见的 N2 率为 8.6%（3/35；95%CI 3.0-22.4），而在阴性内镜超声检查和确认性纵隔镜检查后，未预见的 N2 率为 7.5%（3/40；95%CI 2.6-19.9）。
尽管欧洲 NSCLC 纵隔分期指南对初始使用内镜超声的遵循情况良好，但 30%的内镜超声检查程序进行得不够充分。在阴性内镜超声检查后，经常省略确认性纵隔镜检查。各参与中心在分期策略和程序的系统执行方面存在显著差异。然而，在进行内镜超声检查伴或不伴确认性纵隔镜检查的纵隔分期后，未预见的 N2 率相似。
