Abstract
Herein we examine the need for minimally invasive mediastinal staging for patients
with early-stage non—small cell lung cancer (NSCLC) using endobronchial ultrasound-guided
transbronchial needle aspiration (EBUS-TBNA). Early NSCLC, stages 1 and 2, has a 5-year
survival rate between 53 and 92%, whereas stages 3 and 4 have a 5-year survival of
36% and below. With more favorable outcomes in earlier stages, greater emphasis has
been placed on identifying lung cancer earlier in its disease process. Accurate staging
is crucial as it dictates both prognosis and therapy. Inaccurate staging can adversely
impact surgical candidacy (if falsely “over-staged”) or lead to inadequate treatment
(if “under-staged”). Clinical staging utilizes noninvasive methods to evaluate the
anatomic extent of disease; however, it remains controversial whether mediastinal
staging of early NSCLC with radiological exams alone is sufficient. EBUS-TBNA has
altered the landscape of invasive mediastinal staging and is a crucial component to
improving confidence in lung cancer staging, specifically in early NSCLC. Radiographic
occult lymph node metastasis identified upon review of surgical resection specimens
of early NSCLC may support the argument to perform EBUS-TBNA in all cases of early-stage
disease. Other data suggest that EBUS-TBNA could be spared in cases of peripheral
cT1aN0 and cT1bN0 for which surgical resection with lymph node dissection is planned.
By reviewing reported EBUS-TBNA outcomes in patients with early NSCLC, we aim to emphasize
the necessity of staging with EBUS in this population.
Keywords
staging - mediastinal lymph node metastasis - endobronchial ultrasound - early lung
cancer - non—small cell lung cancer
