title: Endosonographic mediastinal lymph node staging of lung cancer.
abstract: BACKGROUND
  It is unclear whether endoscopic mediastinal lymph node (LN) staging techniques are equivalent to surgical mediastinal staging (SMS) techniques in patients with potentially operable non-small cell lung cancer (NSCLC).
  
  
  METHODS
  A total of 166 patients with confirmed or suspected NSCLC who required SMS based on current guidelines were enrolled in this prospective controlled trial comparing endosonographic mediastinal LN staging with SMS. Each patient served as his or her own control. All patients underwent endobronchial ultrasound (EBUS), endoscopic ultrasound (EUS), and SMS during a single procedure. Results of EBUS, EUS, and combined EBUS/EUS were compared with SMS (gold standard) and in patients with negative LN staging results, with LN sampling at pulmonary resection.
  
  
  RESULTS
  EBUS, EUS, combined EBUS/EUS, and SMS sampled a mean of 2.2, 1.7, 3.9, and 3.1 LN stations, respectively. The prevalence of mediastinal nodal disease (N2/N3) was 32% (53 of 166 patients). The sensitivity, negative predictive value, and diagnostic accuracy of the endoscopic staging modalities, respectively, were EBUS, 72% (95% CI, 0.58-0.83), 88% (0.81-0.93), and 91% (0.85-0.95); EUS, 62% (0.48-0.75), 85% (0.78-0.91), and 88% (0.82-0.92); and combined EBUS/EUS, 91% (0.79-0.97), 96% (0.90-0.99), and 97% (0.93-0.99). Endosonography was diagnostic for N2/N3/M1 disease in 24 patients in whom SMS findings were negative, preventing futile thoracotomy in an additional 14% of patients.
  
  
  CONCLUSIONS
  The combined EBUS/EUS procedure can replace surgical mediastinal staging in patients with potentially resectable NSCLC. Additionally, endosonography leads to improved staging compared with SMS because it allows the biopsy of LNs and metastases unattainable with SMS techniques.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01011595; URL: www.clinicaltrials.gov.
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal, McGill University, Montréal, QC, Canada. Electronic address: moishe.liberman@umontreal.ca.
authors.forename: Moishe
authors.initials: M
authors.lastname: Liberman
authors.affiliation: Department of Epidemiology, McGill University, Montréal, QC, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Sampalis
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal, McGill University, Montréal, QC, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Duranceau
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal, McGill University, Montréal, QC, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Thiffault
authors.affiliation: Department of Pathology, University of Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal, McGill University, Montréal, QC, Canada.
authors.forename: Rachid
authors.initials: R
authors.lastname: Hadjeres
authors.affiliation: CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Division of Thoracic Surgery, University of Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal, McGill University, Montréal, QC, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ferraro
mesh_terms: D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000556:secondary; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies