F-090MINIMALLY INVASIVE STRATEGY OF MEDIASTINAL STAGING OF LUNG CANCER

Objectives: The aim of the study is to analyse the ability of the minimally invasive strategy combining PET, EBUS-NA and EUS-NA to rule out mediastinal nodal metastases of lung cancer. Methods: In consecutive patients with primary lung cancer the preoperative staging included PET scanning, EBUS-NA and EUS-NA. Patients who were re-staged after induction chemotherapy were not included in the study. Those in whom this minimally invasive staging protocol did not confirm mediastinal nodal metastases underwent pulmonary resection with systematic lymph node dissection. The negative predictive values of the combined EBUS-NA/EUS-NA as well as of combined PET/EBUS-NA/EUS-NA were calculated. Results: There were 532 patients (367 men and 165 women), mean age was 65 years (range 30-84). The tumour location was right upper lobe in 134 patients, middle lobe in 24, right lower lobe in 88, right central in 42, left upper lobe in 135, left lower lobe in 80 and left central in 29. There were 276 squamous carcinomas, 150 adenocarcinomas, 22 large cell carcinomas, 40 adeno-squamous carcinomas, 4 small cell carcinomas, 21 carcinoids and 19 other types. There were 421 lobectomies, 55 pneumonectomies, 51 bilobectomies and 5 sublobar resections. In all patients systematic lymph node dissection was performed. The mean number of lymph nodes removed was 22. The negative predictive value of combined EBUS-NA/EUS-NA was 89.8% and for PET/EBUS-NA/EUS-NA it was 93.2%. Conclusions: In patients with lung cancer with mediastinum negative on PET and negative result of combined EBUS-NA/EUS-NA, the risk of mediastinal nodal metastases is low. In these patients invasive mediastinal staging may not be necessary. Disclosure: No significant relationships.