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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2022.1428    [Accepted]
Diagnostic Performance of Endosonography to Detect Mediastinal Lymph Node Metastasis in Patients with Radiological N1 Non-Small Cell Lung Cancer
Bo-Guen Kim1 , Jong Ho Cho2 , Sun Hye Shin3, Kyungjong Lee3, Sang-Won Um3, Hojoong Kim3, Jhingook Kim2, Young Mog Shim2, Byeong-Ho Jeong3
1Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
2Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence  Byeong-Ho Jeong ,Tel: 82-02-3410-3429, Fax: 82-02-3410-3849, Email: myacousticlung@gmail.com
Received: October 29, 2022;  Accepted: February 28, 2023.  Published online: March 2, 2023.
*Bo-Guen Kim and Jong Ho Cho contributed equally to this work.
Guidelines recommend that non-small cell lung cancer (NSCLC) patients with suspected hilar lymph node (LN) metastases should undergo invasive mediastinal LN staging prior to surgical treatment via endosonography. We evaluated the diagnostic performance of endosonography for detecting occult mediastinal metastases (OMM) and determined the factors associated with OMM in NSCLC patients with radiological N1.
Materials and Methods
Patients with confirmed primary NSCLC with radiological N1 who underwent endosonography for nodal staging assessment from January 2013 to December 2019 were retrospectively analyzed.
The prevalence of OMM was found to be 83/279 (29.7%) and only 38.6% (32/83) were diagnosed via endosonography. However, five of them were confirmed as N3 by endosonography. The overall diagnostic sensitivity, negative predictive value, accuracy, and area under the curve of endosonography were 38.6%, 79.4%, 81.7%, and 0.69, respectively. In multivariable analysis, central tumor (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.15–3.68; p=0.016), solid tumor (aOR, 10.24; 95% CI, 1.32–79.49; p=0.026), and adenocarcinoma (aOR, 3.01; 95% CI, 1.63–5.55; p<0.001) were related to OMM in radiological N1 NSCLC patients.
Although the sensitivity of endosonography for detecting OMM was only 40%, the prevalence of OMM was not low (30%) and some cases even turned out to be N3 diseases. Clinicians should be aware that OMM may be more likely in patients with central, solid, and adenocarcinomatous tumor when performing nodal staging in radiological N1 NSCLC via endosonography.
Key words: EBUS, Endosonography, Non-small cell lung cancer, Mediastinal staging, Radiological N1 disease, Occult mediastinal metastasis
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