WCLC 2025 - Posters & ePosters-P2.05.06 Mature Results of a High-Precision Clinical Protocol for Staging Non-Small Cell Lung Cancer (NSCLC) of the Left Lung

P2.05.06 Mature Results of a High-Precision Clinical Protocol for Staging Non-Small Cell Lung Cancer (NSCLC) of the Left Lung

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This study presents mature results from a high-precision clinical protocol using Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) combined with Extended Cervical Mediastinoscopy (ECM) to stage left lung Non-Small Cell Lung Cancer (NSCLC) in patients with normal mediastinum as identified by PET-CT. Conducted at a single center from 2010 to 2023, the protocol aimed to assess the accuracy of VAMLAECM in detecting nodal involvement and the frequency of unsuspected mediastinal lymph node metastases (uN2-3 disease).<br /><br />VAMLA enables bilateral mediastinal lymphadenectomy, exploring lymph nodes from the superior paratracheal to hilar stations, while ECM accesses subaortic and para-aortic nodes. The reference standard for validating negative invasive staging results involved systematic nodal dissection performed during lung surgery.<br /><br />Key findings include a sensitivity and negative predictive value (NPV) of 0.89 and 0.97 respectively for VAMLAECM, with an overall accuracy of 0.98 for detecting nodal metastases. Notably, a high rate of unsuspected N2-3 disease was found, particularly in patients initially staged as cN1 or cT4N0 by PET-CT. The study underscores that without precise invasive mediastinal staging, significant nodal disease—including skip metastases to N3 nodes—would be missed, potentially leading to incorrect treatment decisions at the time of lung resection.<br /><br />The complication rate was low (4.5%), mainly temporary recurrent laryngeal nerve palsy. Based on these results, the authors recommend enhancing invasive staging accuracy via methods like bilateral transcervical lymphadenectomy, to optimally select candidates for neoadjuvant therapy, thereby improving treatment outcomes in left lung NSCLC with normal mediastinum. This comprehensive protocol aligns with ESTS guidelines and provides mature evidence for refining lung cancer staging practices.

Asset Subtitle

Lucia Cabanillas-Paredes

Meta Tag

Speaker Lucia Cabanillas-Paredes

Topic Pulmonology and Staging

Keywords

Video-Assisted Mediastinoscopic Lymphadenectomy

Extended Cervical Mediastinoscopy

Non-Small Cell Lung Cancer

Mediastinal Staging

PET-CT

Nodal Metastases

Unsuspected N2-3 Disease

Sensitivity and Negative Predictive Value

Bilateral Transcervical Lymphadenectomy

Neoadjuvant Therapy Selection