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Endosonography for lung cancer staging: predictors for false-negative outcomes.

Authors :: Talebian Yazdi M
Egberts J
Schinkelshoek MS
Wolterbeek R
Nabers J
Venmans BJ
Tournoy KG
Annema JT
Source :: Lung cancer (Amsterdam, Netherlands) [Lung Cancer] 2015 Dec; Vol. 90 (3), pp. 451-6. Date of Electronic Publication: 2015 Sep 25.
Publication Year :: 2015
Abstract: Objectives: Non-small cell lung cancer (NSCLC) guidelines recommend endosonography (endobronchial [EBUS] and/or transesophageal ultrasound [EUS]) as the initial step for mediastinal tissue staging. Identifying predictors for false negative results could help establish which patients should undergo confirmatory surgical staging.<br />Materials and Methods: 775 NSCLC patients staged negative by EBUS, EUS or combined EUS/EBUS were retrospectively analyzed. Predictors of false-negative outcomes were identified by logistic regression analysis.<br />Results and Conclusion: Three predictors for false-negative outcomes were identified: central location of the lung tumor (OR 3.7/4.5/3.6 for EBUS, EUS and EUS/EBUS respectively, p<0.05), nodal enlargement on CT (OR 3.2/2.5/4.9 for EBUS, EUS and EUS/EBUS respectively, p<0.05) and FDG-avidity of N2/N3 lymph node stations on PET (OR 4.2/4.0/7.5 for EBUS, EUS and EUS/EBUS respectively, p<0.05). One subgroup (peripheral lung tumor, nodal enlargement on CT without FDG-avidity for N2/N3) had a low predicted probability (7.8%) for false-negative EUS. For combined EUS/EBUS, two subgroups were identified: peripheral located tumor with nodal enlargement on CT but without FDG-avidity for N2/N3 (predicted probability 4.7%) and centrally located tumor without affected lymph nodes on CT or PET (predicted probability 3.4%). In conclusion, for specific well-defined subsets of NSCLC patients the low predicted probability of metastasis after negative endosonography might justify omitting confirmatory surgical staging.<br /> (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)