Lung cancer · Staging the mediastinum
Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer
| Design | Randomised controlled trial |
|---|---|
| Treatment | Endosonography (endobronchial and endoscopic ultrasound) followed by surgical staging if negative |
| Control | Surgical staging alone |
| Population | 241 patients with known or suspected non-small-cell lung cancer |
| Follow-up | 6 months |
| Primary endpoint | Sensitivity for mediastinal nodal metastases |
| Result | Sensitivity was 79% (41 of 52, 95% CI 66% to 88%) for surgical staging alone versus 85% (56 of 66, 74% to 92%) for endosonography (p=0.47) and 94% (62 of 66, 85% to 98%) for the combined strategy (p=0.02). Unnecessary thoracotomy occurred in 21 (18%) with mediastinoscopy versus 9 (7%) with endosonography (p=0.02). Complication rates were similar. |
| Secondary endpoints | Unnecessary thoracotomy, complications |
Among patients with (suspected) NSCLC, a staging strategy combining endosonography and surgical staging compared with surgical staging alone resulted in greater sensitivity for mediastinal nodal metastases and fewer unnecessary thoracotomies.
The trial authors, in the published abstract
Made EBUS the first-line mediastinal staging investigation and pushed mediastinoscopy into a confirmatory role. The important number is the 18% to 7% fall in unnecessary thoracotomy — a major operation avoided in one patient in nine.
Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010 Nov 24;304(20):2245-52.