Objectives: The aim of the study was to compare the diagnostic efficiency between combined endobronchial ultrasound (EBUS)/endoesophageal ultrasound (EUS) and transcervical extended mediastinal lymphadenectomy (TEMLA) for preoperative staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC).Material and Methods: Between June 2011 and December 2017, a single-institution prospective randomized trial was conducted, and 250 patients with cytologically confirmed NSCLC, clinical stages cI–IIIA, were included. Positron emission tomography/computed tomography (PET/CT) was performed in all patients. After exclusions, 204 patients were randomized into the EBUS/EUS or TEMLA arms. Patients without N2/N3 metastases after mediastinal staging underwent surgery. The diagnostic yield and complication rates of the EBUS/EUS and TEMLA groups were compared.Results: There were 103 patients in the EBUS/EUS group, and N2 metastases were found in nine cases (8.7%). Ninety-four patients underwent surgery; in six cases, previously unsuspected N2 metastases were revealed. One hundred and one patients were randomized to the TEMLA group, which detected N2/N3 metastases in 15 cases (15.1%). Three patients were not operated on due to postoperative complications following TEMLA. Eighty-three patients underwent surgery, and a single N2 metastatic nodule was detected in one case. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV were 94%, 100%, 99%, 100%, and 99% for TEMLA, respectively, and 60%, 100%, 94%, 100%, and 94% for EBUS/EUS, respectively. There was a significant difference in sensitivity (60% vs. 94%) between the EBUS/EUS and TEMLA groups in favor of the TEMLA group. Postoperative complications occurred in 6/101 (6%) patients after TEMLA, while no complications were observed in the EBUS/EUS group.Conclusions: TEMLA demonstrated superior sensitivity for detecting N2/3 disease compared to EBUS/EUS in terms of diagnostic performance for mediastinal staging of cI–IIIA NSCLC. Due to its more invasive nature, TEMLA was associated with a higher number of complications compared with EBUS/EUS.
目的：本研究旨在比较联合支气管内超声（EBUS）/食管内超声（EUS）与经颈扩大纵隔淋巴结清扫术（TEMLA）在非小细胞肺癌（NSCLC）纵隔淋巴结术前分期中的诊断效能。 材料与方法：2011年6月至2017年12月期间，进行了一项单中心前瞻性随机试验，共纳入250例经细胞学证实、临床分期为cI–IIIA期的NSCLC患者。所有患者均接受正电子发射断层扫描/计算机断层扫描（PET/CT）检查。经排除后，204例患者被随机分配至EBUS/EUS组或TEMLA组。纵隔分期后未发现N2/N3转移的患者接受手术治疗。比较EBUS/EUS组和TEMLA组的诊断检出率和并发症发生率。 结果：EBUS/EUS组共103例患者，其中9例（8.7%）发现N2转移。94例患者接受了手术；其中6例发现了先前未怀疑的N2转移。TEMLA组共101例患者，其中15例（15.1%）检测到N2/N3转移。3例患者因TEMLA术后并发症未行手术。83例患者接受了手术，其中1例发现单个N2转移结节。TEMLA的诊断敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为94%、100%、99%、100%和99%；而EBUS/EUS分别为60%、100%、94%、100%和94%。EBUS/EUS组与TEMLA组在敏感性方面存在显著差异（60% vs. 94%），TEMLA组更优。TEMLA术后有6/101例（6%）患者出现并发症，而EBUS/EUS组未观察到并发症。 结论：在cI–IIIA期NSCLC纵隔分期的诊断性能方面，TEMLA在检测N2/3疾病方面表现出优于EBUS/EUS的敏感性。由于其更具侵入性，TEMLA与EBUS/EUS相比并发症发生率更高。
肿瘤(癌症)患者之家