Dissertation committee:
Βασιλειάδης Ιωάννης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Συρίγος Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κουλούρης Νικόλαος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κουτσούκου Αντωνία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κοτσίνας Αθανάσιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Στεργίου Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημοπούλου Ιωάννα-Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Accurate mediastinal staging in patients with non-small cell lung cancer (NSCLC) is crucial for the determination of optimal treatment management.
Methods: This was a real-life prospective study enrolling 140 patients between December 2016 and August 2018. We aimed to determine the clinical utility of EBUS/EUS-b in mediastinal staging of patients with NSCLC in comparison with integrated PET/CT. Furthermore, SUVmax cut-off value with the highest specificity/accuracy was evaluated. Subgroup analysis according to histological type was performed.
Results: 130 patients were eligible for analysis (mean age ± SD:67,6 ±7,6, males 97). 300 different lymph node stations were sampled (272 through EBUS-TBNA and 28 through EUS-b FNA). Mean SUVmax of all malignant lymph nodes was 7,46 (SD=5,54). Sensitivity, specificity, PPV and NPV of EBUS/EUS-b for the identification of mediastinal malignant lymph nodes was 93,8%, 100%, 100%, and 93,4%, respectively. Accordingly, PET/CT yielded 92,2% sensitivity, 43,9% specificity, 64,8% PPV and 83,3% NPV. For adenocarcinoma (n=76) NPV were 86,2% with EBUS/EUS-b and 75% with PET/CT. NPV for squamous cell (n=46) was 100% with EBUS/EUS-b and 90,9% with PET/CT. EBUS/EUS-b staging yielded excellent agreement with final staging (97,5%, Tau 0,94, p <0,001). ROC curve analysis identified the value 4,95 as the optimal SUV max cut-off value with the best specificity (87,4%) and accuracy (79%) (AUC 0,69, 95% CI: 0,73-0,84, p <0,001).
Conclusions: Thoracic endosonography is an excellent, minimally invasive tool yielding high sensitivity and diagnostic accuracy in mediastinal staging of patients with NSCLC. Implementation of both EBUS/EUS-b and PET/CT is necessary before any surgical intervention.
Keywords:
Lung cancer, EBUS/EUS-b, PET/CT, SUVmax cut-off value, Diagnostic accuracy
