Preoperative Staging Of Lung Cancer Research Articles

WS04.02 Challenges in Imaging Evaluation to Enter Data in the IASLC Database

Soon after the publication of the proposals for the 8thedition of the TNM staging system, the International Association for the Study of Lung Cancer (IASLC) opened a new database for data collection for the next iteration of the lung cancer staging system (1). The database contains more than 450 fields, which address data on patient characteristics, baseline laboratory values, as well as the results of pulmonary function, imaging, and pathological tests. As the database collects the data about lung cancer newly diagnosed between January 1, 2011, and December 31, 2019, the data entered might be predominantly retrospectively collected in some centers. From an imaging perspective, this might lead to a number of problems. First, at least some of the elements required by the database might not be mentioned in the radiological reports. This may necessitate a re-evaluation of the imaging studies by an experienced radiologist, which might not be possible in all centers. Furthermore, the levels of training of the radiologists and reporting across different countries may be variable and thus introduce some degree of imprecision into the quality of the data. As an example, in T staging, particular attention has to be paid to thorough measurements to ensure that the largest diameter in the axial, coronal, or sagittal plane is measured (2). Caution should also be taken not to overdiagnose additional pulmonary nodules as metastases. In N staging, particular attention has to be paid to the lymph node atlas-mining, particularly the well-known pitfall in the correct assignment of lymph nodes at levels 4 and 10 (3-5). Furthermore, the quality of imaging and the availability of more advanced/expensive imaging techniques may also vary from country to country. As an example, the availabilities of PET/CT and/or MRI are not homogenous all over the globe. However, if PET/CT is not performed routinely in operable patients, as many as 20% of unexpected distant metastases might be missed (6). Future staging projects should specifically address these issues in order to further improve the the quality of data necessary to improve the next iteration of the staging system. 1. Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol. 2018;13(6):801-9. 2. Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2016. 3. El-Sherief AH, Lau CT, Obuchowski NA, Mehta AC, Rice TW, Blackstone EH. Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning. Chest. 2017;151(4):776-85. 4. El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics. 2014;34(6):1680-91. 5. Aviram G, Revel MP. Misclassification of Lymph Nodes in Lung Cancer Staging: Can We Improve? Chest. 2017;151(4):733-4. 6. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, et al. Preoperative Staging of Lung Cancer with Combined PET-CT. N Engl J Med. 2009;361(1):32-9. staging, TNM, Lung cancer

WS05.01 Invasive Pre-Operative Staging of Lung Cancer

WS05.01 Invasive Pre-Operative Staging of Lung Cancer

The Pilot Study of Spectral CT for the Diagnosis of Mediastinal Lymph Node Metastasis in Primary Lung Cancer

Objective: To investigate the application value of spectral CT for the diagnosis of mediastinal lymph node metastasis in primary lung cancer. Materials and Methods: 32 patients who had primary lung cancer with 90 enlarged mediastinal lymph nodes underwent spectral CT by using gemstone spectral imaging (GSI) mode. The spectral curves of regions of interest (ROI) in primary lung cancer and mediastinal lymph nodes were measured with GSI post-processing software. The spectral curve slope between 40 and 140 keV was calculated and compared between them for the diagnosis of mediastinal lymph node metastasis. The data were divided into metastatic group (group A) and non-metastatic group (group B) according to the pathologic findings. SPSS17.0 software with paired sample t test was used for statistical analysis and P < 0.05 was considered statistically significant difference. Results: The spectral curve slopes in primary lung cancer and mediastinal lymph node in group B were 0.96 ± 0.13 and 1.32 ± 0.17. There was significant difference between them (t = –2.68, P < 0.05). While there was no significant difference between them in group A (t = –1.62, P > 0.05) with the values of 1.06 ± 0.09 and 1.09 ± 0.12. The accuracy, sensitivity and specificity of diagnosing mediastinal lymph node metastasis were 84.21%, 86.67% and 82.77%, respectively in line with spectral curve. Conclusions: Spectral CT, as a new and non-invasive method, has valuable effect for the diagnosis of mediastinal lymph node metastasis in pre-operative staging of lung cancer.

A comparative study on the diagnosis and staging of lung cancer between mediastinoscopy and EBUS-TBNA

背景与目的支气管镜超声引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA）逐渐普及，但其对肺癌的术前分期和纵隔肿物的诊断价值尚待探讨。本研究拟对比研究EBUS-TBNA和纵隔镜的诊断效能，期望为理性的选择应用提供客观依据。方法收集2009年7月-2012年12月纵隔镜检查术患者361例，其中肺癌199例，纵隔肿物162例；EBUS-TBNA患者348例，其中肺癌216例，纵隔肿物132例。比较两种方法的诊断结果和相关指标，分析二者对肺癌术前分期和纵隔肿物诊断的临床应用价值。结果以石蜡病理学诊断为金标准，纵隔镜检查术的诊断准确性为98.33%，敏感性98.17%，特异性100%；EBUS-TBNA的准确性为90.80%，敏感性90.00%，特异性100%。两者对肺癌的诊断和分期效能无明显差异（P > 0.05），纵隔镜对纵隔肿物的诊断效能较高（P < 0.05）。结论纵隔镜和EBUS-TBNA对肺癌具有相似的的术前诊断和分期作用，但对纵隔肿物的诊断效能则以纵隔镜检查术为高。

Guidelines for multimodality radiological staging of lung cancer

Lung cancer is among the most common type of cancers and is a leading cause of cancer-related deaths with smoking representing the leading risk factor. It is classified into non-small cell lung cancer (NSCLC) representing 70-80% of cases and small cell lung cancer (SCLC) which has neuroendocrine properties with poor outcome. Staging of NSCLC is based on the TNM classification system while SCLC was usually classified into limited and extensive disease, though the use of TNM staging system for SCLC is recommended. Imaging studies are used to determine the pre-operative staging of lung cancer. Accurate radiological staging is essential to determine tumor resectability as well as to avoid futile surgeries and to assess patient's outcome. Moreover, radiological examinations are used for the evaluation of tumor response to treatment. This manuscript will review the utilization of imaging studies in the management of lung cancer based on the most recent guidelines by the National Comprehensive Cancer Network (NCCN).

Integrated PET/CT in the preoperative staging of lung cancer: A prospective comparison of CT, PET and integrated PET/CT

PurposeThe purpose of this study was to evaluate the role of integrated PET/CT in the staging of lung cancer compared with CT alone or PET alone. Materials and methodsThirty-three patients underwent integrated PET/CT for the staging of lung cancer. The tumor, node and metastasis (TNM) stages were assessed with CT, PET and integrated PET–CT and compared with the surgical and pathological staging. ResultsCT correctly evaluated the (T) status in (64%) of the patients, PET in (59%) and PET/CT in (86%). CT correctly evaluated the (N) status in (73%) of the patients, PET in (76%), and PET/CT (88%) with accuracy, sensitivity, specificity, PPV and NPV were 73%, 78%, 71%, 50% and 94% for CT, 76%, 67%, 79%, 55% and 95% for PET and 88%, 89%, 88%, 73% and 100% for PET/CT respectively, and for (M) status were 91%, 86%, 92%, 75% and 96% for CT, 88%, 71%, 92%, 71% and 92% for PET and 97%, 100%, 96%, 88% and 100% for PET/CT respectively. Regarding the overall TNM staging CT correctly staged 24 patients. PET correctly staged 23 cases while PET/CT correctly staged 30 cases. A significant difference in the accuracy of overall tumor staging between PET/CT and CT (P=0.0412) or PET (P=0.0233). ConclusionThe integrated PET/CT is superior to either CT or PET in the staging of lung cancer which has an important impact on selection of the appropriate treatment regimen.

Is There a Role for FDG PET in the Management of Lung Cancer Manifesting Predominantly as Ground-Glass Opacity?

The purposes of our study were to evaluate 18F-FDG PET findings of ground-glass opacity (GGO) nodules and to determine the value of FDG PET for the preoperative staging of lung cancer manifesting predominantly as GGO. Eighty-nine patients (46 men and 43 women; mean [±SD] age, 62.4±7.2 years [range, 33-81 years] and 61.7±6.7 years [range, 34-75 years], respectively) with 134 GGO nodules (56 single and 78 multiple) who underwent CT and FDG PET before surgery were included. CT and PET findings were assessed in terms of lesion size, GGO percentage, multiplicity, and maximum standardized uptake value (SUVmax). SUVmax was correlated with lesion size and GGO percentage using linear regression. The SUVmax and hypermetabolism rates of solitary and multiple GGO nodules were compared using the Student t test or Fisher exact test. Lymph node and distant organ metastasis staging by FDG PET were correlated with histopathologic findings. SUVmax was positively correlated with lesion size (mean, 14.5 mm; range, 5-37 mm) (r=0.6705; p<0.0001) and was negatively correlated with GGO percentage (mean, 77%; range, 50-100%) (r=-0.7465; p<0.0001). Solitary nodules showed higher hypermetabolism rates (73% [41/56]) than did multiple nodules (27% [21/78]) (p=0.0001), but SUVmax was not significantly different between solitary and multiple nodules. There was no true-positive interpretation of nodal or distant metastasis from GGO nodules by FDG PET. FDG PET showed no clear advantage for the staging of lung cancer with predominant GGO because of the low incidences of nodal and distant metastasis.

Combined Use of TBNA and EBUS-TBNA in the Preoperative Staging of Lung Cancer Patients

The identification of the optimal mediastinal staging strategy in lung cancer patients remains an important objective to improve their selection for appropriate treatment. The aim of this study was to analyze our experience with traditional transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as minimally invasive alternative procedures to mediastinoscopy in the preoperative staging of lung cancer patients with positive mediastinal positron emission tomography. Forty-four patients staged N2 or N3 after positron emission tomography were included in the study. Traditional TBNA was used in 15 patients to puncture "easy" targets such as the subcarinal lymph nodes. EBUS-TBNA was used in 29 patients to puncture "difficult" targets such as the paratracheal stations. A malignant adenopathy was identified in 39 patients (89%) who avoided a mediastinoscopy and were referred for neoadjuvant chemotherapy or chemoradiotherapy according to their mediastinal status (N2 or N3), as determined on the positron emission tomography image. In the remaining 5 patients (11%), samples were nondiagnostic. These patients underwent mediastinoscopy and subsequent neoadjuvant chemotherapy (3 cases) or surgery (2 cases) according to the presence of an N2 or an N0 disease. The combined use of traditional and EBUS-TBNA avoided a mediastinoscopy in approximately 90% of lung cancer patients referred for surgery with positive mediastinal positron emission tomography, sparing the associated costs and risks of surgical procedures. Traditional and EBUS-TBNA should be considered as complementary methods in the preoperative staging of lung cancer.

Lung Cancer Staging: An Overview of the New Staging System and Implications for Radiographic Clinical Staging

The Cancer Commission of the League of Nations Health Organization established the Radiological Sub-Commission in 1929 with the primary mandate of creating a common cancer staging system in order to facilitate effective communication across institutions around the world. Shortly thereafter by Dr. Pierre Denoix developed the TNM system used in almost all solid cancer staging today, and he continued to broaden and refine his TNM based staging approach through a series of articles published in the 1940’s and 50’s.1 Denoix’s approach gained its first institutional endorsement when the 7th International Congress of Radiology adopted TNM staging for laryngeal and breast cancer in 1953. Subsequently, as chairman of the Union Contre Le Cancer (UICC) staging committee, Denoix oversaw the publication of a series of “fascicles” (brochures) released during the 1960’s establishing standardized TNM staging for 23 solid organ cancers. A tradition of international consensus in cancer staging was established in 1969, when the American Joint Committee for Cancer Staging and End Results Reporting (renamed American Joint Committee on Cancer in 1980) and the UICC agreed that all subsequent staging recommendations by either body would be published in consultation with the other.2 Lung cancer staging was incorporated into the UICC TNM staging system in 1966. The first substantial revision of the lung cancer TNM staging was proposed by Dr. Mountain et al. in 1973 with the publication of “A Clinical Staging System for Lung Cancer”. This work was based on the outcomes of 2,155 cases of lung cancer, 1,712 of which were non-small cell lung cancer. It further specified the T, N and M descriptors and introduced stage groupings for the first time.3 Over the next 25 years, the lung cancer TNM staging system underwent three major revisions, all based on Dr. Mountain’s growing database, which had increased to 5,319 cases by 1996.4 It was at this point that the International Association for the Study of Lung Cancer (IASLC) initiated the IASLC Lung Cancer Staging Project. The IASLC Lung Staging Project sought to revise lung cancer staging to by using a data set more powerful, current, and universal than any single institutional database. From 1997 until 2009, this group developed a database incorporating patient data gathered from participating institutions around the world, collecting over 81,000 cases of lung cancer. The majority of cases were from Europe and the United States (58% and 21%, respectively), but a significant number of patients from Asia and Australia were included. Patients treated with all modalities were accepted into the database (including surgery, chemotherapy and radiation therapy) in order to better sample the true lung cancer population.2 The 7th edition of the lung cancer staging system thus represents the culmination of a remarkably comprehensive review process. Improvements in surgical, medical and radiation treatments, surveillance, radiographic staging, post-operative care and minimally invasive surgery have all changed lung cancer treatment and survival in the last decade. These new factors have not been accounted for in the previous staging schema and impact treatment decisions. Based on outcomes data from patients treated with these improved modalities, the TNM staging is more representative of current treatment patterns and helps better guide the clinician. The IASLC Lung Cancer Staging Project set out to accomplish a series of goals: Aid the clinician in planning treatment Give some indication of prognosis for each stage Assist in the evaluation of the results of treatment Facilitate the exchange of information between centers across the globe To contribute to the continuing investigation of human cancer.2 This article will review the AJCC 7th edition Cancer Staging for lung cancer and will compare it to the 6th edition, with emphasis on operable disease. Clinical staging, its strengths and weakness, along with minimally invasive staging supplements will be discussed to aid the clinician in the preoperative staging of lung cancer.

PET–CT in Preoperative Staging of Lung Cancer

To the Editor: During an ongoing analysis of our randomized trial of the use of combined positron-emission tomography and computed tomography (PET–CT) in the preoperative staging of non–small-cell lung cancer (July 2, 2009, issue),1 we discovered an error in the reported data.2 Three patients who were randomly assigned to the PET–CT group and who were initially coded as having undergone PET–CT did not receive this diagnostic test. The primary end point of our study was the number of futile thoracotomies that had been performed, as determined by the intention-to-treat analysis. Thus, the error does not change the published outcome. We . . .

Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial

Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC. The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT)-here number of PET/CT scans needed-to avoid one futile thoracotomy. All monetary estimates were inflated to 2010 <euro>. The incremental cost of the PET/CT-based regimen was estimated at 3,927 <euro> [95% confidence interval (CI) -3,331; 10,586] and the NNT at 4.92 (95% CI 3.00; 13.62). These resulted in an average incremental cost-effectiveness ratio of 19,314 <euro>, which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 <euro> per avoided futile thoracotomy. When costs of comorbidity-related hospital services were excluded, the PET/CT regimen appeared dominant. Applying a full health care sector perspective, the cost-effectiveness of PET/CT for staging NSCLC seems to depend on the willingness to pay in order to avoid a futile thoracotomy. However, given that four outliers in terms of extreme comorbidity were all randomized to the PET/CT arm, there is uncertainty about the conclusion. When hospital costs of comorbidity were excluded, the PET/CT regimen was found to be both more accurate and cost saving.

ACR Appropriateness Criteria® on Metastatic Bone Disease

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.

Preoperative Staging of Lung Cancer with Combined PET–CT

Preoperative Staging of Lung Cancer with Combined PET–CT

Preoperative Staging of Lung Cancer with Combined PET–CT

Preoperative Staging of Lung Cancer with Combined PET–CT

Lung-Cancer Staging with PET–CT

To the Editor: In their assessment of the usefulness of combined positron-emission tomography and computed tomography (PET–CT) in the preoperative staging of lung cancer, Fischer et al. (July 2 issue)1 provide no information on the interval between baseline staging and thoracotomy, nor on the use of neoadjuvant therapy. A prolonged delay between PET–CT and surgery may negate the diagnostic value of PET–CT and may be due to coexisting conditions that would themselves have a negative effect on survival. Although the PET–CT scans in the study were read by an experienced radiologist and a nuclear medicine specialist, it is unclear who interpreted the diagnostic CT scans and whether the final tumor–node–metastasis (TNM) stage was determined by the same investigators in all patients or whether the stage was decided locally. These factors are important for assessing the influence of observer bias on the study results.

Preoperative Staging of Lung Cancer with Combined PET–CT

Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC. We randomly assigned patients who were referred for preoperative staging of NSCLC to either conventional staging plus PET-CT or conventional staging alone. Patients were followed until death or for at least 12 months. The primary end point was the number of futile thoracotomies, defined as any one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause within 1 year after randomization. From January 2002 through February 2007, we randomly assigned 98 patients to the PET-CT group and 91 to the conventional-staging group. Mediastinoscopy was performed in 94% of the patients. After PET-CT, 38 patients were classified as having inoperable NSCLC, and after conventional staging, 18 patients were classified thus. Sixty patients in the PET-CT group and 73 in the conventional-staging group underwent thoracotomy (P=0.004). Among these thoracotomies, 21 in the PET-CT group and 38 in the conventional-staging group were futile (P=0.05). The number of justified thoracotomies and survival were similar in the two groups. The use of PET-CT for preoperative staging of NSCLC reduced both the total number of thoracotomies and the number of futile thoracotomies but did not affect overall mortality. (ClinicalTrials.gov number, NCT00867412.)

The clinical impact of integrated FDG PET–CT on management decisions in patients with lung cancer

To retrospectively evaluate the clinical impact of FDG PET-CT on the management pathway of patients with lung cancer. One hundred and sixty-one patients with suspected lung cancer undergoing FDG PET-CT during the study period were analyzed. Before PET-CT, lung cancer MDT recorded scan indication, conventional clinical stage, and proposed treatment plan. The accuracy of integrated PET-CT compared with stand alone CT in preoperative staging of lung cancer was evaluated with pathological staging used as the reference standard. The effect of PET-CT on the subsequent management of patients was also evaluated. The agreement between CT and integrated PET-CT in preoperative staging of lung cancer was significant (p<0.001). In 16 (10%) patients PET-CT excluded tumour as there was no FDG uptake. PET-CT revealed occult metastasis in 25 (16%) patients. It was also a better overall predictor for T status (64% vs. 58%) and N status (78% vs. 65%). For N staging PET-CT was more accurate for N1 (82% vs. 72%) and N2 (85% vs. 80%) disease. Regression analyses suggested that PET-CT was a better predictor of overall TNM staging for lung cancer. FDG PET scanning changed or influenced management decisions in 66 (41%) patients with lung cancer. Changes in TNM staging following PET-CT were significant predictors (p=0.02) in making a decision to abandon thoracotomies. Addition of PET-CT to comprehensive evaluation of lung cancer can have significant clinical impact. There is marked improvement in staging the disease. Patients were frequently spared unnecessary treatment, and management was more appropriately targeted. PET permits reduction in the number of thoracotomies performed for non-resectable disease with predicted reduction in the morbidity rate and cost associated with unnecessary interventions.

Positron emission tomography scanning is coming to a hospital near you soon!

Positron emission tomography (PET) is still generally not available in the UK; however, there are plans to introduce a national service in England from April 2008. Plans are also at an advanced stage in Scotland and Wales. The main uses of PET are in preoperative staging of lung cancer, detection of recurrent colorectal cancer, and management of patients with lymphoma. Although these provide the bulk of the referral base, PET is also of use in specific situations in patients with less common cancers, such as head and neck cancer, gynaecological cancer, and melanoma. In its more common uses, PET has been shown to be cost effective. Positron emission tomography will play an increasing role in the evaluation of response to treatment to enable early separation of patients who are responding well to chemotherapy from those who are not responding and need to be transferred to another therapy.

Endoscopic Ultrasound Added to Mediastinoscopy for Preoperative Staging of Patients With Lung Cancer

Up to 40% of thoracotomies performed for non-small cell lung cancer are unnecessary, predominantly due to inaccurate preoperative detection of lymph node metastases and mediastinal tumor invasion (T4). Mediastinoscopy and the novel, minimally invasive technique of transesophageal ultrasound-guided fine-needle aspiration (EUS-FNA) target different mediastinal lymph node stations. In addition, EUS can identify tumor invasion in neighboring organs if tumors are located adjacent to the esophagus. To investigate the additional value of EUS-FNA to mediastinoscopy in the preoperative staging of patients with non-small cell lung cancer. Prospective, nonrandomized multicenter trial performed in 1 referral and 5 general hospitals in the Netherlands. During a 3-year period (2000-2003), 107 consecutive patients with potential resectable non-small cell lung cancer underwent preoperative staging by both EUS-FNA and mediastinoscopy. Patients underwent thoracotomy with tumor resection if mediastinoscopy was negative. Surgical-pathological staging was compared with preoperative findings and the added benefit of the combined strategy was assessed. The EUS-FNA examination was performed as an additional staging test to mediastinoscopy in all patients. Detection of mediastinal tumor invasion (T4) and lymph node metastases (N2/N3) comparing the combined staging by both EUS-FNA and mediastinoscopy with staging by mediastinoscopy alone. The combination of EUS-FNA and mediastinoscopy identified more patients with tumor invasion or lymph node metastases (36%; 95% confidence interval [CI], 27%-46%) compared with either mediastinoscopy alone (20%; 95% CI, 13%-29%) or EUS-FNA (28%; 95% CI, 19%-38%) alone. This indicated that 16% of thoracotomies could have been avoided by using EUS-FNA in addition to mediastinoscopy. However, 2% of the EUS-FNA findings were false-positive. These preliminary findings suggest that EUS-FNA, when added to mediastinoscopy, improves the preoperative staging of lung cancer due to the complementary reach of EUS-FNA in detecting mediastinal lymph node metastases and the ability to assess mediastinal tumor invasion.

The value of autofluorescence bronchoscopy in the pre-operative staging of lung cancer

PURPOSE: Autofluorescence bronchoscopy (AFB) is an established method for detection of pre-/early malignant lesions. Many studies have shown an increased detection rate in risk groups when autofluorescence was combined with white light bronchoscopy (WLB). The aim of this study is to determine whether the routine application of AFB in the pre-operative diagnostic of lung cancer gives relevant additional information regarding further therapy especially about anatomic operability or synchronous existence of pre-/early malignant changes.