TY - JOUR
T1 - Guideline adherence of mediastinal staging of non-small cell lung cancer
T2 - A multicentre retrospective analysis
AU - Bousema, Jelle E.
AU - van Dorp, Martijn
AU - Hoeijmakers, Fieke
AU - Huijbregts, Ilse A.
AU - Barlo, Nicole P.
AU - Bootsma, Gerben P.
AU - van Boven, WimJan P.
AU - Claessens, Niels J. M.
AU - Dingemans, Anne-Marie C.
AU - Hanselaar, Wessel E.
AU - Kortekaas, Robert Th. J.
AU - Lardenoije, Jan-Willem H. P.
AU - Maessen, Jos G.
AU - Schreurs, W. Hermien
AU - Vissers, Yvonne
AU - Youssef-El Soud, Maggy
AU - Dijkgraaf, Marcel G. W.
AU - Annema, Jouke T.
AU - van den Broek, Frank J. C.
N1 - Funding Information:
Dr. Bousema and Dr. van den Broek report grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr. Annema reports non-financial support from Hitachi Medical systems and Pentax and a grant from Cook medical, outside the submitted work. Dr. van Dorp, Dr. Hoeijmakers, E. Huijbregts, Dr. Barlo, Dr. Bootsma, Dr. Van Boven, Dr. Claessens, Prof. Dr. Dingemans, Dr. Hanselaar, Dr. Kortekaas, Dr. Lardenoije, Prof. Dr. Maessen, Dr. Schreurs, Dr. Vissers, Dr. Youssef-El Soud and Prof. Dr. Dijkgraaf have nothing to disclose.
Funding Information:
This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313).
Funding Information:
This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313).
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/8
Y1 - 2019/8
N2 - Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy.Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline.Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed 'systematically' in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy.Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.
AB - Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy.Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline.Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed 'systematically' in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy.Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.
KW - ENDOSONOGRAPHY
U2 - 10.1016/j.lungcan.2019.05.031
DO - 10.1016/j.lungcan.2019.05.031
M3 - Article
SN - 0169-5002
VL - 134
SP - 52
EP - 58
JO - Lung Cancer
JF - Lung Cancer
ER -