Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer

作者：Jouke T. Annema, Jan P. van Meerbeeck, Robert C. Rintoul, Christophe Dooms, Ellen Deschepper, Olaf M. Dekkers, Paul De Leyn, Jerry Braun, Nicholas Carroll, Marleen Praet, Frédéric De Ryck, Johan Vansteenkiste, Frank Vermassen, Michel I.M. Versteegh, Maud Veseliç, Andrew G. Nicholson, Klaus F. Rabe, Kurt G. Tournoy · 发表于：JAMA · 年份：2010 · DOI：10.1001/jama.2010.1705 · 被引用次数：617 · 研究领域：Lung Cancer Diagnosis and Treatment、Tracheal and airway disorders、Lung Cancer Treatments and Mutations

CONTEXT: Mediastinal nodal staging is recommended for patients with resectable non-small cell lung cancer (NSCLC). Surgical staging has limitations, which results in the performance of unnecessary thoracotomies. Current guidelines acknowledge minimally invasive endosonography followed by surgical staging (if no nodal metastases are found by endosonography) as an alternative to immediate surgical staging. OBJECTIVE: To compare the 2 recommended lung cancer staging strategies. DESIGN, SETTING, AND PATIENTS: Randomized controlled multicenter trial (Ghent, Leiden, Leuven, Papworth) conducted between February 2007 and April 2009 in 241 patients with resectable (suspected) NSCLC in whom mediastinal staging was indicated based on computed or positron emission tomography. INTERVENTION: Either surgical staging or endosonography (combined transesophageal and endobronchial ultrasound [EUS-FNA and EBUS-TBNA]) followed by surgical staging in case no nodal metastases were found at endosonography. Thoracotomy with lymph node dissection was performed when there was no evidence of mediastinal tumor spread. MAIN OUTCOME MEASURES: The primary outcome was sensitivity for mediastinal nodal (N2/N3) metastases. The reference standard was surgical pathological staging. Secondary outcomes were rates of unnecessary thoracotomy and complications. RESULTS: Two hundred forty-one patients were randomized, 118 to surgical staging and 123 to endosonography, of whom 65 also underwent surgical staging. Nodal ...