Combining endosonography modalities improves mediastinal nodal staging
medwireNews: In patients with non-small-cell lung cancer, mediastinal nodal metastases can be detected with improved accuracy by using endobronchial endoscopy (EBUS) and esophageal endoscopy (EUS) in tandem, shows a meta-analysis.
Researcher Daniël Korevaar, from the University of Amsterdam in the Netherlands, and colleagues explain that “[a]ccurate mediastinal staging of lung cancer is crucial because the stage of disease directly determines the prognosis and guides treatment options.”
They add that the combined use of the two minimally invasive approaches could reduce the need for surgical staging procedures.
The team used data from 13 studies – comprising a total of 2395 patients – that investigated the accuracy of combined EBUS and EUS to detect mediastinal nodal disease in patients with potentially curable lung cancer.
As reported in The Lancet Respiratory Medicine, the combined approach had a mean sensitivity for mediastinal nodal staging of 86% and a negative predictive value (NPV) of 92%.
The sensitivity increased by an average 12% with the addition of EUS to EBUS, and by an average 22% when EBUS was added to EUS.
The corresponding mean increases in the detection rate were 4% and 7%, which equated to a number needed to test to detect one false-negative case of 25 for an EBUS-first strategy and 14 for an EUS-first approach.
The study authors recommend that healthcare providers consider using the combined strategy to detect mediastinal nodal metastases. “We especially recommend its use in clinics that currently only perform EUS because the increase in sensitivity after adding EBUS to EUS is substantially larger than the other way around,” they write.
Korevaar et al continue: “Additional surgical staging after a negative result with the combined approach might still be considered to rule out mediastinal nodal involvement in high-prevalence settings because the negative predictive value was significantly lower than in low-prevalence settings.”
Specifically, the NPV was 93% for studies in which the prevalence of mediastinal nodal metastases was equal to or lower than the median prevalence of 34%. This was significantly higher than the 89% NPV for studies with a prevalence over 34%.
In a related comment, Raymond Osarogiagbon, from the Baptist Cancer Center in Memphis, Tennessee, USA, says that “[t]his is valuable information with which to promote the dissemination of these minimally-invasive mediastinal nodal sampling techniques.”
He adds: “Clearly, a standardised approach to mediastinal nodal sampling with strategic use of minimally invasive procedures makes a lot of sense from a patient-centred perspective, enabling patients and their physicians to make optimum treatment decisions with the minimum of risk.”
medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016