WCLC 2025 - Posters & ePosters-EP.05.08 Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) for Staging cN0-N1 Non-Small Cell Lung Cancer

EP.05.08 Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) for Staging cN0-N1 Non-Small Cell Lung Cancer

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This retrospective single-center study (2017–2024) assessed the performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in 112 patients with clinical N0-N1 non-small cell lung cancer (NSCLC) as determined by PET-CT. Current guidelines recommend invasive mediastinal staging in patients with suspected nodal involvement or normal mediastinum, yet EBUS-TBNA sensitivity in this group remains low.<br /><br />Key findings include a low sensitivity of EBUS-TBNA (36% in cN0 and 27% in cN1) for detecting mediastinal nodal metastases (N2 disease), despite high specificity (100%). The study identified a 20.5% rate of unsuspected N2 disease (uN2), indicating that one in five patients clinically staged as N0-N1 had occult mediastinal metastases. Most uN2 cases involved single-level nodal disease and were predominantly adenocarcinomas.<br /><br />Multivariate analysis revealed cN1 status and higher tumor stages (cT3-4N0) as independent risk factors for uN2, with odds ratios of approximately 3.5 for both factors. This underlines the importance of thorough staging in these subsets to avoid understaging and improper treatment.<br /><br />Importantly, the study emphasizes the added value of video-assisted mediastinoscopic lymphadenectomy (VAMLA) in confirming negative EBUS-TBNA findings. VAMLA, combined with systemic nodal dissection during lung resection when appropriate, improved staging accuracy and could serve as a reference standard, particularly in patients with cT3-4N0 and cN1 tumors and a normal mediastinum on imaging.<br /><br />In conclusion, EBUS-TBNA shows limited sensitivity for mediastinal staging in cN0-1 NSCLC, with significant rates of occult N2 disease. Incorporating confirmatory invasive procedures like VAMLA enhances detection accuracy, enabling better treatment planning and potentially improving patient outcomes in this clinical setting.

Asset Subtitle

Lucia Cabanillas-Paredes

Meta Tag

Speaker Lucia Cabanillas-Paredes

Topic Pulmonology and Staging

Keywords

EBUS-TBNA

mediastinal staging

non-small cell lung cancer

NSCLC

clinical N0-N1

PET-CT

occult N2 disease

video-assisted mediastinoscopic lymphadenectomy

VAMLA

mediastinal nodal metastases