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Semin Respir Crit Care Med 2022; 43(04): 503-511
DOI: 10.1055/s-0042-1748189
Review Article

Mediastinal Staging with Endobronchial Ultrasound in Early-Stage Non—Small Cell Lung Cancer: Is It Necessary?

Authors

  • Bryan C. Husta

    1   Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States

  • Or Kalchiem-Dekel

    1   Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States

  • Jason A. Beattie

    1   Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States

  • Kazuhiro Yasufuku

    2   Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto

Funding This research was funded in part through the National Cancer Institute, National Institutes of Health [Grants P30 CA008748 to Memorial Sloan Kettering Cancer Center (authors B.C.H., O.K.-D., J.A.B.)
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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


Publication History

Article published online:
14 September 2022

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