The following is a summary of “Integral mediastinal staging in patients with NON-SMALL cell lung cancer and risk factors for occult N2 disease,” published in the MARCH 2023 issue of Pulmonology by Lucena, et al.

Patients who have non-small cell lung cancer (NSCLC) are more likely to develop occult mediastinal metastases (OMM) if they have aberrant hiliar lymph nodes (clinical N1; cN1), a central tumor site, or a large tumor (diameter >3 cm). For a study, researchers sought to examine prospectively the diagnostic usefulness of an integral mediastinal staging (IMS) approach that combined Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) and Video-Assisted Mediastinoscopy (VAM) in patients with NSCLC at risk of OMM.

Patients with NSCLC who had a radiologically normal mediastinum as determined noninvasively by positron emission tomography and computed tomography of the chest (PET-CT) and who also had OMM risk factors (cN1, central tumor, and/or >3 cm) had EBUS-TBNA and, if the results were negative, VAM. The tumor was surgically removed from those whose IMS results were negative.

EBUS-TBNA found OMM in 2 of the 49 patients tested (4%), and VAM was found in 1 of the 47 patients who had negative EBUS (2%). At surgery, OMM was present in two patients with negative IMS. OMM was present in 10% of people overall. EBUS-TBNA has a negative likelihood ratio of 0.60 (95%CI:0.30-1.16), a negative predictive value (NPV) of 93.6%, and a sensitivity of 40%. After EBUS, the likelihood of missing an OMM diagnosis was 6%, whereas after IMS, it was 4.4%.

Except maybe in patients with cN1 illness who needed additional study, integral mediastinal staging in patients with NSCLC and clinical risk factors for OMM did not seem to add diagnostic value to that of EBUS-TBNA.