The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease

Introduction: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone....

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Autores principales:	Rosa Cordovilla, Marco López-Zubizarreta, Antonio Velasco, Alberto Álvarez, Marta Rodríguez, Asunción Gómez, Miguel Ángel Hernández-Mezquita, Miguel Iglesias
Formato:	article
Lenguaje:	EN
Publicado:	Karger Publishers 2021
Materias:	endobronchial ultrasound endoscopic ultrasound staging lung cancer radiographically normal mediastinum Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/42bffed74a0e4384823fad1f8e079906
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spelling	oai:doaj.org-article:42bffed74a0e4384823fad1f8e0799062021-11-04T14:40:32ZThe Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease2296-687010.1159/000519034https://doaj.org/article/42bffed74a0e4384823fad1f8e0799062021-10-01T00:00:00Zhttps://www.karger.com/Article/FullText/519034https://doaj.org/toc/2296-6870Introduction: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. Material and Methods: A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. Results: Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). Conclusions: In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.Rosa CordovillaMarco López-ZubizarretaAntonio VelascoAlberto ÁlvarezMarta RodríguezAsunción GómezMiguel Ángel Hernández-MezquitaMiguel IglesiasKarger Publishersarticleendobronchial ultrasoundendoscopic ultrasoundstaginglung cancerradiographically normal mediastinumMedicine (General)R5-920ENBiomedicine Hub, Vol 6, Iss 3, Pp 92-101 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	endobronchial ultrasound endoscopic ultrasound staging lung cancer radiographically normal mediastinum Medicine (General) R5-920
spellingShingle	endobronchial ultrasound endoscopic ultrasound staging lung cancer radiographically normal mediastinum Medicine (General) R5-920 Rosa Cordovilla Marco López-Zubizarreta Antonio Velasco Alberto Álvarez Marta Rodríguez Asunción Gómez Miguel Ángel Hernández-Mezquita Miguel Iglesias The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
description	Introduction: We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. Material and Methods: A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. Results: Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). Conclusions: In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.
format	article
author	Rosa Cordovilla Marco López-Zubizarreta Antonio Velasco Alberto Álvarez Marta Rodríguez Asunción Gómez Miguel Ángel Hernández-Mezquita Miguel Iglesias
author_facet	Rosa Cordovilla Marco López-Zubizarreta Antonio Velasco Alberto Álvarez Marta Rodríguez Asunción Gómez Miguel Ángel Hernández-Mezquita Miguel Iglesias
author_sort	Rosa Cordovilla
title	The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_short	The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_full	The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_fullStr	The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_full_unstemmed	The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease
title_sort	value of a systematic protocol using endobronchial ultrasound and endoscopic ultrasound in staging of lung cancer for patients with imaging in0–n1 disease
publisher	Karger Publishers
publishDate	2021
url	https://doaj.org/article/42bffed74a0e4384823fad1f8e079906
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The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease

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