Invasive staging of non-small cell lung cancer - A review of the current evidence

被引:250
作者
Toloza, EM
Harpole, L
Detterbeck, F
McCrory, DC
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[3] Duke Univ, Med Ctr, Ctr Clin Hlth Policy Res, Durham, NC 27710 USA
[4] Dept Vet Affairs Med Ctr, Durham, NC USA
[5] Univ N Carolina, Dept Surg, Chapel Hill, NC USA
关键词
biopsy needle; false-negative rates; lung neoplasm; lymphatic metastasis; mediastinoscopy; predictive value of tests; sensitivity and specificity;
D O I
10.1378/chest.123.1_suppl.157S
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objectives: To determine the test performance characteristics of transbronchial needle aspiration (TBNA), transthoracic needle aspiration (TTNA), endoscopic ultrasound-guided needle aspiration (EUS-NA), and mediastinoscopy in staging non-small cell lung cancer (NSCLC). Design, setting, and participants: Systematic search of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies. included were studies comparing staging results of TBNA, TTNA, EUS-NA, or mediastinoscopy against either tissue histologic confirmation or long-term clinical follow-up (greater than or equal to 1 year). Patients included were those with NSCLC or small cell lung cancer. Measurement and results: For patients with lung cancer, the pooled sensitivity for TBNA was 0.76, the pooled specificity was 0.96, and the negative predictive value (NPV) was 0.71. For TTNA, the pooled sensitivity was 0.91, with an NPV of 0.78. EUS-NA had a pooled sensitivity of 0.88, a pooled specificity of 0.91, and an NPV of 0.77. For standard cervical mediastinoscopy, the pooled sensitivity was 0.81, with an NPV of 0.91. The addition of either extended cervical mediastinoscopy or anterior mediastinotomy to standard cervical mediastinoscopy appeared to improve the sensitivity of any of the procedures alone. Conclusions: Invasive clinical staging of NSCLC can be performed effectively by TBNA, TTNA, EUS-NA, or mediastinoscopy. Selection of the appropriate study is dependent on the degree of suspicion for metastatic disease, the patient's comorbid illnesses, and the availability and performance characteristics of procedural options.
引用
收藏
页码:157S / 166S
页数:10
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