Complete and systematic mediastinal nodal staging for lung cancer (SCORE study)>

Wieneke Buikhuisen, Peter Bonta, Kurt Tournoy, Olga Schuurbiers, Laurence M.M.J. Crombag, Jouke Annema, Sayed Hashemi, Daniel Korevaar, Jos Stigt, Christophe Dooms, Maarten Ninaber

Research output: Contribution to conferencePaperAcademic

Abstract

Background: Guidelines recommend endosonography for mediastinal nodal staging of lung cancer but do not specify how: through endobronchial (EBUS), esophageal (EUS-(B) or both? Additionally, there is no consensus whether endosonography should be performed systematically or target abnormal CT-PET findings only.Hypothesis: Complete (combined endobronchial and esophageal) and systematic (assessment of all hilar and mediastinal nodal regions including routine sampling of station 4R, 7, 4L) endosonographic staging using a single EBUS scope improves loco-regional staging (N2, N3) versus targeted (PET-CT directed) EBUS staging alone.Methods: Prospective, multicentre international study in patients with resectable (suspected) NSCLC. Prior to endoscopy, target nodal station (s) were defined based on imaging (PET-CT). Patients underwent a systematic EBUS followed by a systematic EUS-B procedure using the EBUS scope. Node(s) suspicious on CT/PET and/or EBUS/EUS-B imaging were sampled as well as stations 4R, 4L and 7 (in case short axis > 8 mm). Surgical pathological staging was the reference standard.Results: 229 patients underwent EBUS and EUS-B. The prevalence of mediastinal N2/3 disease was 45% (103/229). A (PET-) CT guided targeted nodal approach by EBUS identified 81 patients with N2-3 disease (sensitivity 79%, NPV 85%). 4 additional patients with N2/3 disease were found by systematic EBUS (sensitivity 83%, NPV 88%) and 5 more by EUS-B (90 patients total – sensitivity 87%, NPV 91%).Conclusion: Complete (EBUS and EUS-B) and systematic endosonographic mediastinal staging is superior to a targeted EBUS ‘hit and run’ strategy based on CT (PET) findings.
Original languageEnglish
DOIs
Publication statusPublished - 19 Dec 2017

Cite this

Buikhuisen, Wieneke ; Bonta, Peter ; Tournoy, Kurt ; Schuurbiers, Olga ; Crombag, Laurence M.M.J. ; Annema, Jouke ; Hashemi, Sayed ; Korevaar, Daniel ; Stigt, Jos ; Dooms, Christophe ; Ninaber, Maarten. / Complete and systematic mediastinal nodal staging for lung cancer (SCORE study)>.
@conference{7b21bda5230944869b12b96616afd1e0,
title = "Complete and systematic mediastinal nodal staging for lung cancer (SCORE study)>",
abstract = "Background: Guidelines recommend endosonography for mediastinal nodal staging of lung cancer but do not specify how: through endobronchial (EBUS), esophageal (EUS-(B) or both? Additionally, there is no consensus whether endosonography should be performed systematically or target abnormal CT-PET findings only.Hypothesis: Complete (combined endobronchial and esophageal) and systematic (assessment of all hilar and mediastinal nodal regions including routine sampling of station 4R, 7, 4L) endosonographic staging using a single EBUS scope improves loco-regional staging (N2, N3) versus targeted (PET-CT directed) EBUS staging alone.Methods: Prospective, multicentre international study in patients with resectable (suspected) NSCLC. Prior to endoscopy, target nodal station (s) were defined based on imaging (PET-CT). Patients underwent a systematic EBUS followed by a systematic EUS-B procedure using the EBUS scope. Node(s) suspicious on CT/PET and/or EBUS/EUS-B imaging were sampled as well as stations 4R, 4L and 7 (in case short axis > 8 mm). Surgical pathological staging was the reference standard.Results: 229 patients underwent EBUS and EUS-B. The prevalence of mediastinal N2/3 disease was 45{\%} (103/229). A (PET-) CT guided targeted nodal approach by EBUS identified 81 patients with N2-3 disease (sensitivity 79{\%}, NPV 85{\%}). 4 additional patients with N2/3 disease were found by systematic EBUS (sensitivity 83{\%}, NPV 88{\%}) and 5 more by EUS-B (90 patients total – sensitivity 87{\%}, NPV 91{\%}).Conclusion: Complete (EBUS and EUS-B) and systematic endosonographic mediastinal staging is superior to a targeted EBUS ‘hit and run’ strategy based on CT (PET) findings.",
author = "Wieneke Buikhuisen and Peter Bonta and Kurt Tournoy and Olga Schuurbiers and Crombag, {Laurence M.M.J.} and Jouke Annema and Sayed Hashemi and Daniel Korevaar and Jos Stigt and Christophe Dooms and Maarten Ninaber",
year = "2017",
month = "12",
day = "19",
doi = "10.1183/1393003.congress-2017.oa1468",
language = "English",

}

Complete and systematic mediastinal nodal staging for lung cancer (SCORE study)> / Buikhuisen, Wieneke; Bonta, Peter; Tournoy, Kurt; Schuurbiers, Olga; Crombag, Laurence M.M.J.; Annema, Jouke; Hashemi, Sayed; Korevaar, Daniel; Stigt, Jos; Dooms, Christophe; Ninaber, Maarten.

2017.

Research output: Contribution to conferencePaperAcademic

TY - CONF

T1 - Complete and systematic mediastinal nodal staging for lung cancer (SCORE study)>

AU - Buikhuisen, Wieneke

AU - Bonta, Peter

AU - Tournoy, Kurt

AU - Schuurbiers, Olga

AU - Crombag, Laurence M.M.J.

AU - Annema, Jouke

AU - Hashemi, Sayed

AU - Korevaar, Daniel

AU - Stigt, Jos

AU - Dooms, Christophe

AU - Ninaber, Maarten

PY - 2017/12/19

Y1 - 2017/12/19

N2 - Background: Guidelines recommend endosonography for mediastinal nodal staging of lung cancer but do not specify how: through endobronchial (EBUS), esophageal (EUS-(B) or both? Additionally, there is no consensus whether endosonography should be performed systematically or target abnormal CT-PET findings only.Hypothesis: Complete (combined endobronchial and esophageal) and systematic (assessment of all hilar and mediastinal nodal regions including routine sampling of station 4R, 7, 4L) endosonographic staging using a single EBUS scope improves loco-regional staging (N2, N3) versus targeted (PET-CT directed) EBUS staging alone.Methods: Prospective, multicentre international study in patients with resectable (suspected) NSCLC. Prior to endoscopy, target nodal station (s) were defined based on imaging (PET-CT). Patients underwent a systematic EBUS followed by a systematic EUS-B procedure using the EBUS scope. Node(s) suspicious on CT/PET and/or EBUS/EUS-B imaging were sampled as well as stations 4R, 4L and 7 (in case short axis > 8 mm). Surgical pathological staging was the reference standard.Results: 229 patients underwent EBUS and EUS-B. The prevalence of mediastinal N2/3 disease was 45% (103/229). A (PET-) CT guided targeted nodal approach by EBUS identified 81 patients with N2-3 disease (sensitivity 79%, NPV 85%). 4 additional patients with N2/3 disease were found by systematic EBUS (sensitivity 83%, NPV 88%) and 5 more by EUS-B (90 patients total – sensitivity 87%, NPV 91%).Conclusion: Complete (EBUS and EUS-B) and systematic endosonographic mediastinal staging is superior to a targeted EBUS ‘hit and run’ strategy based on CT (PET) findings.

AB - Background: Guidelines recommend endosonography for mediastinal nodal staging of lung cancer but do not specify how: through endobronchial (EBUS), esophageal (EUS-(B) or both? Additionally, there is no consensus whether endosonography should be performed systematically or target abnormal CT-PET findings only.Hypothesis: Complete (combined endobronchial and esophageal) and systematic (assessment of all hilar and mediastinal nodal regions including routine sampling of station 4R, 7, 4L) endosonographic staging using a single EBUS scope improves loco-regional staging (N2, N3) versus targeted (PET-CT directed) EBUS staging alone.Methods: Prospective, multicentre international study in patients with resectable (suspected) NSCLC. Prior to endoscopy, target nodal station (s) were defined based on imaging (PET-CT). Patients underwent a systematic EBUS followed by a systematic EUS-B procedure using the EBUS scope. Node(s) suspicious on CT/PET and/or EBUS/EUS-B imaging were sampled as well as stations 4R, 4L and 7 (in case short axis > 8 mm). Surgical pathological staging was the reference standard.Results: 229 patients underwent EBUS and EUS-B. The prevalence of mediastinal N2/3 disease was 45% (103/229). A (PET-) CT guided targeted nodal approach by EBUS identified 81 patients with N2-3 disease (sensitivity 79%, NPV 85%). 4 additional patients with N2/3 disease were found by systematic EBUS (sensitivity 83%, NPV 88%) and 5 more by EUS-B (90 patients total – sensitivity 87%, NPV 91%).Conclusion: Complete (EBUS and EUS-B) and systematic endosonographic mediastinal staging is superior to a targeted EBUS ‘hit and run’ strategy based on CT (PET) findings.

UR - http://www.mendeley.com/research/complete-systematic-mediastinal-nodal-staging-lung-cancer-score-study

UR - http://www.mendeley.com/research/complete-systematic-mediastinal-nodal-staging-lung-cancer-score-study

U2 - 10.1183/1393003.congress-2017.oa1468

DO - 10.1183/1393003.congress-2017.oa1468

M3 - Paper

ER -