TY - JOUR
T1 - Adherence to the mediastinal staging guideline and unforeseen N2 disease in patients with resectable non-small cell lung cancer: Nationwide results from the Dutch Lung Cancer Audit - Surgery
T2 - Nationwide results from the Dutch Lung Cancer Audit - Surgery
AU - Bousema, Jelle E.
AU - Heineman, David J.
AU - Dijkgraaf, Marcel G. W.
AU - Annema, Jouke T.
AU - van den Broek, Frank J. C.
N1 - Copyright © 2020 Elsevier B.V. All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - Objectives: Invasive mediastinal staging is advised by guidelines in patients with resectable non-small cell lung cancer (NSCLC) and suspicious lymph nodes (cN1-3) or for central, FDG-non-avid or peripheral tumours >3 cm. Our objective was to assess current guideline adherence and consequent unforeseen N2 disease (uN2) in NSCLC patients having various indications for mediastinal staging. Materials and methods: We analysed the Dutch Lung Cancer Audit – Surgery data of all patients who underwent a primary lung resection with lymph node dissection for NSCLC in 2017-2018. Based on the 2015 ESTS-ERS-ESGE guideline we assessed the use of initial endosonography and confirmatory mediastinoscopy as well as uN2 rates. Results: A total of 2238 patients were analysed. 43 % (95 %-CI: 41–45) underwent initial endosonography followed by a confirmatory mediastinoscopy in 44 % (95 %-CI:40–47) of them, resulting in a 19 % (95 %-CI: 17–20) rate of properly staged patient according to the guidelines. uN2 was demonstrated in 12.5 % (95 %-CI: 9.7–16.0) of correctly staged patients compared to 10.9 % (95 %-CI: 9.6–12.4) who were not (p = .36). The highest uN2 rate was found in cN1-3 patients who were not staged (23.0 %, 95 %-CI: 16.4–31.2) compared to 13.0 % (95 %-CI: 9.7–17.1) who were (p = .01). Conclusion: Guideline adherence in Dutch NSCLC patients with an indication for invasive mediastinal staging is poor. The highest uN2 rate was found in unstaged cN1-3 patients, suggesting that this subgroup may benefit from an appropriate staging conform guidelines.
AB - Objectives: Invasive mediastinal staging is advised by guidelines in patients with resectable non-small cell lung cancer (NSCLC) and suspicious lymph nodes (cN1-3) or for central, FDG-non-avid or peripheral tumours >3 cm. Our objective was to assess current guideline adherence and consequent unforeseen N2 disease (uN2) in NSCLC patients having various indications for mediastinal staging. Materials and methods: We analysed the Dutch Lung Cancer Audit – Surgery data of all patients who underwent a primary lung resection with lymph node dissection for NSCLC in 2017-2018. Based on the 2015 ESTS-ERS-ESGE guideline we assessed the use of initial endosonography and confirmatory mediastinoscopy as well as uN2 rates. Results: A total of 2238 patients were analysed. 43 % (95 %-CI: 41–45) underwent initial endosonography followed by a confirmatory mediastinoscopy in 44 % (95 %-CI:40–47) of them, resulting in a 19 % (95 %-CI: 17–20) rate of properly staged patient according to the guidelines. uN2 was demonstrated in 12.5 % (95 %-CI: 9.7–16.0) of correctly staged patients compared to 10.9 % (95 %-CI: 9.6–12.4) who were not (p = .36). The highest uN2 rate was found in cN1-3 patients who were not staged (23.0 %, 95 %-CI: 16.4–31.2) compared to 13.0 % (95 %-CI: 9.7–17.1) who were (p = .01). Conclusion: Guideline adherence in Dutch NSCLC patients with an indication for invasive mediastinal staging is poor. The highest uN2 rate was found in unstaged cN1-3 patients, suggesting that this subgroup may benefit from an appropriate staging conform guidelines.
KW - Endosonography
KW - Mediastinal lymph node staging
KW - Mediastinoscopy
KW - Non-small cell lung cancer
KW - Thoracic surgery
KW - Unforeseen N2 disease
KW - Adenocarcinoma of Lung/pathology
KW - Aged
KW - Carcinoma, Non-Small-Cell Lung/pathology
KW - Carcinoma, Squamous Cell/pathology
KW - Female
KW - Follow-Up Studies
KW - Guideline Adherence/statistics & numerical data
KW - Humans
KW - Lung Neoplasms/pathology
KW - Male
KW - Mediastinal Neoplasms/pathology
KW - Neoplasm Staging
KW - Positron Emission Tomography Computed Tomography
KW - Practice Guidelines as Topic/standards
KW - Pulmonary Surgical Procedures
UR - http://www.scopus.com/inward/record.url?scp=85079607871&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.lungcan.2020.02.008
DO - https://doi.org/10.1016/j.lungcan.2020.02.008
M3 - Article
C2 - 32088606
SN - 0169-5002
VL - 142
SP - 51
EP - 58
JO - Lung cancer (Amsterdam, Netherlands)
JF - Lung cancer (Amsterdam, Netherlands)
ER -