Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Res Treat. 2023 Jul;55(3):832-840. doi: 10.4143/crt.2022.1428. Epub 2023 Mar 2.
Guidelines recommend that non-small cell lung cancer (NSCLC) patients with suspected hilar lymph node (LN) metastases should undergo invasive mediastinal LN staging prior to surgical treatment via endosonography. We evaluated the diagnostic performance of endosonography for detecting occult mediastinal metastases (OMM) and determined the factors associated with OMM in NSCLC patients with radiological N1.
Patients with confirmed primary NSCLC with radiological N1 who underwent endosonography for nodal staging assessment from January 2013 to December 2019 were retrospectively analyzed.
The prevalence of OMM was found to be 83/279 (29.7%) and only 38.6% (32/83) were diagnosed via endosonography. However, five of them were confirmed as N3 by endosonography. The overall diagnostic sensitivity, negative predictive value, accuracy, and area under the curve of endosonography were 38.6%, 79.4%, 81.7%, and 0.69, respectively. In multivariable analysis, central tumor (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.15 to 3.68; p=0.016), solid tumor (aOR, 10.24; 95% CI, 1.32 to 79.49; p=0.026), and adenocarcinoma (aOR, 3.01; 95% CI, 1.63 to 5.55; p < 0.001) were related to OMM in radiological N1 NSCLC patients.
Although the sensitivity of endosonography for detecting OMM was only 40%, the prevalence of OMM was not low (30%) and some cases even turned out to be N3 diseases. Clinicians should be aware that OMM may be more likely in patients with central, solid, and adenocarcinomatous tumor when performing nodal staging in radiological N1 NSCLC via endosonography.
指南建议疑似肺门淋巴结（LN）转移的非小细胞肺癌（NSCLC）患者在接受超声内镜（endosonography）治疗前应进行侵袭性纵隔 LN 分期。我们评估了超声内镜检测隐匿性纵隔转移（OMM）的诊断性能，并确定了影像学 N1 的 NSCLC 患者中与 OMM 相关的因素。
回顾性分析了 2013 年 1 月至 2019 年 12 月期间因淋巴结分期评估而行超声内镜检查的确诊原发性 NSCLC 伴影像学 N1 的患者。
发现 OMM 的患病率为 279 例中的 83 例（29.7%），而仅 38.6%（32/83）通过超声内镜检查确诊。然而，其中 5 例通过超声内镜检查被确认为 N3。超声内镜的总体诊断敏感性、阴性预测值、准确性和曲线下面积分别为 38.6%、79.4%、81.7%和 0.69。在多变量分析中，中央肿瘤（调整优势比 [aOR]，2.05；95%置信区间 [CI]，1.15 至 3.68；p=0.016）、实体肿瘤（aOR，10.24；95%CI，1.32 至 79.49；p=0.026）和腺癌（aOR，3.01；95%CI，1.63 至 5.55；p<0.001）与影像学 N1 NSCLC 患者的 OMM 相关。
尽管超声内镜检测 OMM 的敏感性仅为 40%，但 OMM 的患病率并不低（30%），有些病例甚至被诊断为 N3 疾病。在影像学 N1 NSCLC 患者中通过超声内镜进行淋巴结分期时，临床医生应该意识到中央、实体和腺癌肿瘤患者更有可能发生 OMM。
