UTILITY OF ENDOBRONCHIAL ULTRASOUND-GUIDED LYMPH NODE BIOPSY IN RADIOGRAPHIC STAGE 1 LUNG CANCER

Abstract

TYPE: Abstract Publication TOPIC: Procedures PURPOSE: Current guidelines recommend using endobronchial ultrasound guided lymph node biopsy (EBUS) in staging non-small cell lung cancer (NSCLC) with evidence of lymphatic metastasis, in primary tumor located centrally, and in tumors > 3cm in size. In patients with radiographic stage 1 (RS1) there are no recommendations on EBUS, yet it is still widely performed. We aim to show that in radiographic stage 1 NSCLC, surveillance of all mediastinal and hilar nodes is not necessary. METHODS: A retrospective study identifying patients that underwent an EBUS from January 2005 to May 2019 in adult patients who underwent both a CT and PET/CT that showed a RS1 lung nodule prior to an EBUS. All included patients had proven NSCLC from the identified nodule. RESULTS: 188 patients were included with demographic data displayed in Table 1. Of those, 13 (6.9%; 95% CI, 4.1%-11.5%) had a positive lymph node with 6 (3.2%; 95% CI, 1.5%-6.8%) were N1 nodes and 7 (3.7%; 95% CI, 1.8%-7.5%) were N2 nodes. Multivariate analysis with the significant variables in univariate anaylsis showed that only the amount of smoking was significant to upstaging lymph nodes (p=0.04). CONCLUSIONS: This study supports the use of EBUS for staging RS1 lung cancer, but with limited lymph node surveillance showing no positive N3 nodes in our cohort which shows sampling of N3 nodes is not indicated in RS1 tumors. CLINICAL IMPLICATIONS: EBUS is stil extremely valuable, but this study supports less lymph node sampling in specific patients. DISCLOSURE: No significant relationships. KEYWORDS: lung cancer, EBUS, Staging