Endosonography combined with surgical staging has greater sensitivity for detecting mediastinal nodal metastases, according to results of a randomized, controlled trial published in the November 24 issue of JAMA.
For this study, researchers compared this combined staging strategy with the current standard of surgical staging in patients with resectable non–small-cell lung cancer (NSCLC). Between February 2007 and April 2009, they randomized 241 patients with suspected NSCLC. Patients were staged using surgical staging alone (n = 118) or endosonography (n = 123), which was defined as transesophageal and endobronchial ultrasound, followed by surgical staging if no nodal metastases were found at endosonography (n = 65). The primary outcome was sensitivity for mediastinal nodal (N2/N3) metastases, and the reference standard was surgical pathological staging.
The researchers found nodal metastases in 35% of patients in the surgical staging group (95% CI, 27%-44%) compared with 46% of patients in the ednosonography group (95%CI, 37%-54%; P = .11) and in 50% of patients whose endosonography was followed by surgical staging (95% CI, 42%-59%; P = .02). This corresponded to sensitivities of 79% (41/52; 95% CI, 66%-88%) compared with 85% (56/66; 95% CI, 74%-92%; P = .47) and 94% (62/66; 95% CI, 85%-98%; P = .02), respectively. The complication rate was similar in both groups.
The researchers concluded that because staging with endosonogrpahy significantly improves the detection of nodal metastases and reduces the rate of unnecessary thoracotomies, this combined staging strategy could be superior to surgical staging in the detection of nodal disease. Further, this strategy offers staging without the need for general anesthesia and is considered cost-effective.