Endoscopic biopsy of lymph nodes between the two lungs (mediastinum) is a sensitive and accurate technique that can replace mediastinal surgery for staging lung cancer in patients with potentially resectable tumours. Such were the conclusions of a prospective controlled trial conducted under Dr. Moishe Liberman, a researcher at the CHUM Research Centre (CRCHUM) and an Associate Professor at the Université de Montréal. Moreover, the study showed that it is not necessary to perform surgery to confirm negative results obtained through the endoscopic approach during the pre-operative evaluation of patients with this type of cancer. This discovery has many advantages for both the patients and the health-care system.
Endoscopic biopsy of the lymph nodes is a minimally invasive, non-surgical intervention that has recently begun to be used to stage lung cancer. The study conducted by Dr. Liberman’s team involved 166 patients with confirmed or suspected non small cell lung cancer, and was designed to compare the new approach to surgical staging under general anesthesia, as prescribed in current guidelines for this type of cancer. The findings, which were recently published in CHEST Journal, the official publication of the American College of Chest Physicians, show that the endoscopy approach is not only sensitive and accurate, but also leads to improved staging compared to surgical staging due to its ability to biopsy lymph nodes and metastases not attainable with surgical techniques.
All patients underwent endobronchial ultrasound (EBUS), endoscopic ultrasound (EUS) and surgical mediastinal staging (SMS) during a single procedure. Each subject served as his or her own control. The results of the EBUS, EUS and combined EBUS/EUS were compared to SMS (gold standard) results and, in patients with negative lymph node staging, to lymph node sampling at pulmonary resection.
- Moishe Liberman, John Sampalis, André Duranceau, Vicky Thiffault, Rachid Hadjeres, Pasquale Ferraro. Endosonographic Mediastinal Lymph Node Staging of Lung Cancer. CHEST Journal, 2014; 146 (2): 389 DOI: 10.1378/chest.13-2349