Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA.
Department of Biology, Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA.
Clin Respir J. 2021 Jun;15(6):676-682. doi: 10.1111/crj.13344. Epub 2021 Mar 8.
The use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is currently recommended for staging non-small cell lung cancer (NSCLC) in centrally located tumors, tumors >3 cm, or with radiologic evidence of lymph node (LN) metastasis. Current guidelines do not recommend staging EBUS-TBNA in patients with stage I NSCLC who do not have any of the aforementioned conditions.
We hypothesize that using EBUS-TBNA is useful for detecting occult metastasis in radiologic stage I NSCLC.
In this single-center, retrospective study, charts of patients ≥18 years old who underwent staging EBUS-TBNA from January 2005 to May 2019 were reviewed. Only patients with combined positron-emission tomography and computed tomography (PET/CT) scans consistent with radiologic stage I NSCLC were included. Identified variables included: age, gender, personal history of any cancer, smoking history, tumor location, tumor centrality, tumor size, tumor PET activity, histopathologic type of NSCLC, and LN biopsy results. Patients whose LN samples showed a diagnosis other than NSCLC were excluded. The association between LN positivity, and each of the variables was assessed using Pearson's correlation for categorical variables, and logistic regression analysis for continuous variables.
From the 2,892 initially screened patients, 188 were included. Of those, 13 (6.9%; 95% CI, 4%-11%) had a malignancy-positive LN biopsy. The number needed to test (NNT) in order to detect one case of any occult metastasis was 15. Among the included variables, a significant association was found between LN positivity and tumor centrality, with central tumors found in 61.5% of patients with positive LN (n = 8) (p < 0.01). This association stayed significant after adjusting for age, gender, smoking history, tumor size, tumor location, and PET activity (p = 0.015). Among patients with malignancy-positive LN biopsies, five (38.5%; 95% CI, 17.6%-64.6%) were upstaged to N1, and eight (61.5%; 95% CI, 35.4%-82.4%) were upstaged to N2, with NNT of 23 to detect one case of occult N2 metastasis. Subgroup analysis comparing LN-positive patients based on their N stage did not show statistically significant association with any of the variables.
Based on our results and along with the existing evidence, EBUS-TBNA should be recommended as part of the routine staging in all patients with radiologic stage I NSCLC.
目前推荐使用支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）对中央型肺癌、直径＞3cm 的肿瘤或有影像学证据的淋巴结（LN）转移的非小细胞肺癌（NSCLC）进行分期。目前的指南不建议对没有上述任何条件的 I 期 NSCLC 患者进行分期 EBUS-TBNA。
我们假设使用 EBUS-TBNA 有助于检测影像学 I 期 NSCLC 中的隐匿性转移。
在这项单中心回顾性研究中，对 2005 年 1 月至 2019 年 5 月期间接受分期 EBUS-TBNA 的年龄≥18 岁的患者的病历进行了回顾。仅纳入符合影像学 I 期 NSCLC 的综合正电子发射断层扫描和计算机断层扫描（PET/CT）检查的患者。确定的变量包括：年龄、性别、任何癌症的个人史、吸烟史、肿瘤位置、肿瘤中心性、肿瘤大小、肿瘤 PET 活性、非小细胞肺癌的组织病理学类型和 LN 活检结果。排除 LN 样本显示非 NSCLC 诊断的患者。使用 Pearson 相关系数评估 LN 阳性与每个变量之间的关联，对连续变量使用逻辑回归分析。
从最初筛选的 2892 名患者中，纳入了 188 名患者。其中，13 名（6.9%；95%CI，4%-11%）患者的 LN 活检显示恶性肿瘤阳性。为了检测到一个隐匿性转移病例，需要检测的病例数（NNT）为 15。在纳入的变量中，LN 阳性与肿瘤中心性之间存在显著关联，阳性 LN 患者中 61.5%（n=8）的肿瘤为中央型（p＜0.01）。在调整年龄、性别、吸烟史、肿瘤大小、肿瘤位置和 PET 活性后，这种关联仍然具有统计学意义（p=0.015）。在 LN 活检恶性肿瘤阳性的患者中，5 名（38.5%；95%CI，17.6%-64.6%）被升级为 N1，8 名（61.5%；95%CI，35.4%-82.4%）被升级为 N2，检测到一个隐匿性 N2 转移病例的 NNT 为 23。基于 N 分期对 LN 阳性患者进行亚组分析，与任何变量均无统计学关联。
根据我们的结果和现有的证据，EBUS-TBNA 应被推荐作为所有影像学 I 期 NSCLC 患者常规分期的一部分。
