WCLC 2025 - Posters & ePosters-EP.05.05 Invasive Mediastinal Staging of NSCLC Using Vamla: Results and Perspectives

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This study from the Moscow City Hospital evaluates the effectiveness of video-assisted mediastinoscopic lymphadenectomy (VAMLA) for invasive mediastinal staging in patients with non-small cell lung cancer (NSCLC). Accurate mediastinal staging is crucial since resectability and treatment strategies depend on the presence and extent of mediastinal lymph node (N) involvement, particularly N2 disease.<br /><br />The study included 110 patients (median age 65) with indications for invasive staging such as centrally located tumors, tumor size ≥30 mm, lymphadenopathy, or clinically suspected N1 disease, treated between August 2020 and December 2024. Adenocarcinoma and squamous cell carcinoma were the predominant histologic types; 32.4% had centrally located tumors.<br /><br />Results showed that VAMLA led to a change in clinical TNM staging in 53% of cases, with 41% upstaged and 11% downstaged after invasive staging. This influenced therapeutic decisions: 57.2% underwent surgery, 39.1% received neoadjuvant chemo-immunotherapy, and 3.6% received chemoradiotherapy. Compared to PET-CT, VAMLA demonstrated higher clinical accuracy and a low false-negative rate, highlighting the limitations of PET-CT SUV values in conclusively diagnosing lymph node metastases.<br /><br />Multifactorial analysis identified central tumor location, adenocarcinoma histology, and higher lymph node SUV as significant predictors of N2-3 disease. A predictive calculator for N2 probability was developed to guide staging decisions.<br /><br />In conclusion, invasive mediastinal staging using VAMLA is warranted when it has potential to alter treatment plans. VAMLA offers superior accuracy over non-invasive imaging modalities. Tumor histology, localization, and PET SUV should inform indications for invasive assessment in the era of multimodal NSCLC management.

Asset Subtitle

Yury Esakov

Meta Tag

Speaker Yury Esakov

Topic Pulmonology and Staging

Keywords

Video-assisted mediastinoscopic lymphadenectomy

VAMLA

Invasive mediastinal staging

Non-small cell lung cancer

NSCLC

Mediastinal lymph node involvement

N2 disease

PET-CT accuracy

Neoadjuvant chemo-immunotherapy

Predictive calculator for N2 probability