title: Minimally invasive strategy for mediastinal staging of patients with lung cancer.
abstract: BACKGROUND
  The exclusion of mediastinal involvement in patients with non-small cell lung cancer is essential for choosing an appropriate therapy.
  
  
  OBJECTIVE
  The aim of the study was to analyze the ability of a new minimally invasive strategy combining positron emission tomography (PET), endobronchial ultrasound needle aspiration (EBUS-NA), and endoscopic ultrasound needle aspiration (EUS-NA) to exclude mediastinal nodal metastases of non-small cell lung cancer.
  
  
  METHODS
  In a group of consecutive patients with primary non-small cell lung cancer, the preoperative assessment of medisastinal lymph nodes using PET, EBUS-NA, and EUS-NA. Patients in whom this minimally invasive staging protocol did not confirm mediastinal nodal metastases underwent pulmonary resection with systematic lymph node dissection. The negative predictive values of the combined EBUS-NA/EUS-NA as well as PET/EBUS -NA/EUS-NA were calculated.
  
  
  RESULTS
  We analyzed data of 532 patients (367 men and 165 women; mean age, 65 years [range, 30-84 years]). Squamous carcinoma were diagnosed in 276 patients; adenocarcinoma, in 150; large cell carcinoma, in 22; adenosquamous carcinoma, in 40; small cell carcinoma, in 4; carcinoids, in 21; and other histological types, in 19. We performed 421 lobectomies, 55 pneumonectomies, 51 bilobectomies, and 5 sublobar resections. In all patients, systematic lymph node dissection was performed. The mean number of removed lymph nodes was 22. The negative predictive value of EBUS-NA/EUS-NA was 89.8% and of PET/EBUS-NA/EUS-NA-93.2%.
  
  
  CONCLUSIONS
  Patients with lung cancer with negative results of PET, EBUS-NA, and EUS-NA are at low risk of mediastinal nodal metastasis. In these patients, invasive mediastinal staging may not be necessary.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Hauer
authors.forename: Artur
authors.initials: A
authors.lastname: Szlubowski
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Żanowska
authors.forename: Lucyna
authors.initials: L
authors.lastname: Rudnicka-Sosin
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Trybalski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Grochowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gil
authors.forename: Janusz
authors.initials: J
authors.lastname: Włodarczyk
authors.forename: Janusz
authors.initials: J
authors.lastname: Warmus
authors.forename: Piotr
authors.initials: P
authors.lastname: Kocoń
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smęder
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kużdżał
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008875:Middle Aged; D049268:Positron-Emission Tomography