Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer
Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer
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DOI：
10.1093/ejcts/ezu028
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发表时间：
2014-05-01
影响因子：
3.4
通讯作者：
Zielinski, Marcin
中科院分区：
文献类型：
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作者：
De Leyn, Paul;Dooms, Christophe;Zielinski, Marcin
对于可能可切除的非小细胞肺癌（NSCLC）患者，准确的术前分期和纵隔淋巴结再分期至关重要。 2007年，欧洲胸外科医师学会（ESTS）发布了一种整合影像学、内窥镜和手术技术的术前纵隔分期算法。 2009 年，国际肺癌研究协会 (IASLC) 推出了新的淋巴结图。该图的一些变化对纵隔分期有重要影响。此外，已有更多不同纵隔分期技术的证据。因此，需要对 ESTS 指南进行修订。如果出现计算机断层扫描 (CT) 放大或正电子发射断层扫描 (PET) 阳性纵隔淋巴结，则需要进行组织确认。内超声检查[支气管内超声检查（EBUS）/食管超声检查（EUS）]结合细针抽吸（FNA）是首选（如果有），因为它是微创的，并且对纵隔淋巴结疾病的诊断具有很高的敏感性。如果阴性，则需要进行淋巴结清扫或活检的手术分期。视频辅助纵隔镜检查优于纵隔镜检查。内窥镜分期和手术分期的结合使用可以获得最高的准确性。当 CT 上没有肿大的淋巴结以及 PET 或 PET-CT 上没有淋巴结摄取时，对于位于肺外三分之一处 < 3 cm 的肿瘤，需要进行直接手术切除和系统性淋巴结清扫。对于中央肿瘤或 N1 淋巴结，需要进行术前纵隔分期。选择 EBUS/EUS 和 FNA 内镜分期还是视频辅助纵隔镜检查取决于当地的专业知识，以遵守分期的最低要求。对于>3cm的肿瘤，建议术前进行纵隔分期，主要是标准化摄取值高的腺癌。对于重新分期，建议采用提供组织学信息的侵入性技术。内窥镜技术和外科手术均可用，但与基线分期获得的结果相比，其阴性预测值较低。使用内窥镜分期技术证明纵隔淋巴结疾病和纵隔镜检查以评估诱导治疗后淋巴结反应的综合策略需要进一步研究。
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours < 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours > 3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.