Chest
Volume 123, Issue 1, Supplement, January 2003, Pages 157S-166S
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Invasive Staging of Non-small Cell Lung Cancer*: A Review of the Current Evidence

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Study objectives

To determine the test performance characteristics of transbronchial needle aspiration (TBNA), transthoracic needle aspiration (TTNA), endoscopic ultrasound-guided needle aspiration (EUS-NA), and mediastinoscopy in staging non-small cell lung cancer (NSCLC).

Design, setting, and participants

Systematic search of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies. Included were studies comparing staging results of TBNA, TTNA, EUS-NA, or mediastinoscopy against either tissue histologic confirmation or long-term clinical follow-up (≥ 1 year). Patients included were those with NSCLC or small cell lung cancer.

Measurement and results

For patients with lung cancer, the pooled sensitivity for TBNA was 0.76, the pooled specificity was 0.96, and the negative predictive value (NPV) was 0.71. For TTNA, the pooled sensitivity was 0.91, with an NPV of 0.78. EUS-NA had a pooled sensitivity of 0.88, a pooled specificity of 0.91, and an NPV of 0.77. For standard cervical mediastinoscopy, the pooled sensitivity was 0.81, with an NPV of 0.91. The addition of either extended cervical mediastinoscopy or anterior mediastinotomy to standard cervical mediastinoscopy appeared to improve the sensitivity of any of the procedures alone.

Conclusions

Invasive clinical staging of NSCLC can be performed effectively by TBNA, TTNA, EUS-NA, or mediastinoscopy. Selection of the appropriate study is dependent on the degree of suspicion for metastatic disease, the patient's comorbid illnesses, and the availability and performance characteristics of procedural options.

Section snippets

Materials and Methods

To evaluate the usefulness of TBNA, TTNA, EUS-NA, mediastinoscopy, and mediastinotomy in determining the presence or absence of metastatic disease in mediastinal lymph nodes, we analyzed published studies that reported the ability of the various invasive methods to correctly establish the pathologic stage of newly diagnosed or suspected lung cancer. In this review, needle aspiration is considered a type of biopsy. The terms needle aspiration and needle biopsy are, thus, considered

Results

As described above, data were abstracted and analyzed three ways. However, the results obtained by all three methods were essentially the same; therefore, we present results for scenario two, which assesses the ability of an invasive procedure to adequately stage patients with suspected lung cancer (either NSCLC or SCLC). In this scenario, patients enrolled in the study but suspected of having a diagnosis other than lung cancer were not considered evaluable and were excluded, where possible.

Discussion

Clinical staging is based on all information obtained about the primary tumor, its draining lymph node basins, and potential distant sites of metastasis prior to treatment initiation. Accurate clinical staging is paramount not only for estimating a patient's life expectancy and 5-year survival probability, but also because it directly impacts on the selection of appropriate therapy.

Clinical staging has been shown to differ markedly from pathologic staging at the time of resection. In a large

References (53)

  • WP Luke et al.

    Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung

    Thorac Cardiovasc Surg

    (1986)
  • RJ Ginsberg et al.

    Extended cervical mediastinoscopy: a single staging procedure for bronchogenic carcinoma of the left upper lobe

    Thorac Cardiovasc Surg

    (1987)
  • LA Best et al.

    The contribution of anterior mediastinotomy in the diagnosis and evaluation of diseases of the mediastinum and lung

    Ann Thorac Surg

    (1987)
  • Y Watanabe et al.

    Aggressive surgical intervention in N2 non-small cell cancer of the lung

    Ann Thorac Surg

    (1991)
  • KM Pisters et al.

    Induction chemotherapy before surgery for early-stage lung cancer: a novel approach

    Thorac Cardiovasc Surg

    (2000)
  • CS White et al.

    Transbronchial needle aspiration: guidance with CT fluoroscopy

    Chest

    (2000)
  • R Rosell et al.

    A randomized trial comparing preoperative chemotherapy plus surgery with surgery alone in patients with non-small-cell lung cancer

    N Engl J Med

    (1994)
  • JA Roth et al.

    A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage IIIA non-small-cell lung cancer

    J Natl Cancer Inst

    (1994)
  • FC Detterbeck et al.

    Intrathoracic staging

  • J Lau

    Meta-Test, version 0.6

    (1997)
  • EM Harrow et al.

    The utility of transbronchial needle aspiration in the staging of bronchogenic carcinoma

    Am J Respir Crit Care Med

    (2000)
  • S Bilaceroglu et al.

    Comparison of rigid and flexible transbronchial needle aspiration in the staging of bronchogenic carcinoma

    Respiration

    (1998)
  • ML Wilsher et al.

    Transtracheal aspiration using rigid bronchoscopy and a rigid needle for investigating mediastinal masses

    Thorax

    (1996)
  • F Rodriguez de Castro et al.

    Transbronchial fine needle aspiration in clinical practice

    Cytopathology

    (1995)
  • J Vansteenkiste et al.

    Transcarinal needle aspiration biopsy in the staging of lung cancer

    Eur Respir J

    (1994)
  • DA Schenk et al.

    Comparison of the Wang 19-gauge and 22-gauge needles in the mediastinal staging of lung cancer

    Am Rev Respir Dis

    (1993)
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