Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis

Jelle E. Bousema; Martijn van Dorp; Fieke Hoeijmakers; Ilse A. Huijbregts; Nicole P. Barlo; Gerben P. Bootsma; Wim Jan P. van Boven; Niels J.M. Claessens; Anne Marie C. Dingemans; Wessel E. Hanselaar; Robert Th J. Kortekaas; Jan Willem H.P. Lardenoije; Jos G. Maessen; W. Hermien Schreurs; Yvonne Vissers; Maggy Youssef-El Soud; Marcel G.W. Dijkgraaf; Jouke T. Annema; Frank J.C. van den Broek

doi:10.1016/j.lungcan.2019.05.031

Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis

Jelle E. Bousema, Martijn van Dorp, Fieke Hoeijmakers, Ilse A. Huijbregts, Nicole P. Barlo, Gerben P. Bootsma, Wim Jan P. van Boven, Niels J.M. Claessens, Anne Marie C. Dingemans, Wessel E. Hanselaar, Robert Th J. Kortekaas, Jan Willem H.P. Lardenoije, Jos G. Maessen, W. Hermien Schreurs, Yvonne Vissers, Maggy Youssef-El Soud, Marcel G.W. Dijkgraaf, Jouke T. Annema, Frank J.C. van den Broek^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

16 Citations (Scopus)

Abstract

Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy. Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline. Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed ‘systematically’ in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy. Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.

Original language	English
Pages (from-to)	52-58
Number of pages	7
Journal	Lung Cancer
Volume	134
DOIs	https://doi.org/10.1016/j.lungcan.2019.05.031
Publication status	Published - Aug 2019
Externally published	Yes

Bibliographical note

Funding Information:
Dr. Bousema and Dr. van den Broek report grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr. Annema reports non-financial support from Hitachi Medical systems and Pentax and a grant from Cook medical, outside the submitted work. Dr. van Dorp, Dr. Hoeijmakers, E. Huijbregts, Dr. Barlo, Dr. Bootsma, Dr. Van Boven, Dr. Claessens, Prof. Dr. Dingemans, Dr. Hanselaar, Dr. Kortekaas, Dr. Lardenoije, Prof. Dr. Maessen, Dr. Schreurs, Dr. Vissers, Dr. Youssef-El Soud and Prof. Dr. Dijkgraaf have nothing to disclose.

Funding Information:
This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313).

Funding Information:
This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313).

Publisher Copyright:
© 2019 Elsevier B.V.

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10.1016/j.lungcan.2019.05.031

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Bousema, J. E., van Dorp, M., Hoeijmakers, F., Huijbregts, I. A., Barlo, N. P., Bootsma, G. P., van Boven, W. J. P., Claessens, N. J. M., Dingemans, A. M. C., Hanselaar, W. E., Kortekaas, R. T. J., Lardenoije, J. W. H. P., Maessen, J. G., Schreurs, W. H., Vissers, Y., Youssef-El Soud, M., Dijkgraaf, M. G. W., Annema, J. T., & van den Broek, F. J. C. (2019). Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis. Lung Cancer, 134, 52-58. https://doi.org/10.1016/j.lungcan.2019.05.031

@article{d4935e2a6464419bbbf1143b6ad53054,

title = "Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis",

abstract = "Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy. Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline. Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed {\textquoteleft}systematically{\textquoteright} in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy. Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.",

author = "Bousema, {Jelle E.} and {van Dorp}, Martijn and Fieke Hoeijmakers and Huijbregts, {Ilse A.} and Barlo, {Nicole P.} and Bootsma, {Gerben P.} and {van Boven}, {Wim Jan P.} and Claessens, {Niels J.M.} and Dingemans, {Anne Marie C.} and Hanselaar, {Wessel E.} and Kortekaas, {Robert Th J.} and Lardenoije, {Jan Willem H.P.} and Maessen, {Jos G.} and Schreurs, {W. Hermien} and Yvonne Vissers and {Youssef-El Soud}, Maggy and Dijkgraaf, {Marcel G.W.} and Annema, {Jouke T.} and {van den Broek}, {Frank J.C.}",

note = "Funding Information: Dr. Bousema and Dr. van den Broek report grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr. Annema reports non-financial support from Hitachi Medical systems and Pentax and a grant from Cook medical, outside the submitted work. Dr. van Dorp, Dr. Hoeijmakers, E. Huijbregts, Dr. Barlo, Dr. Bootsma, Dr. Van Boven, Dr. Claessens, Prof. Dr. Dingemans, Dr. Hanselaar, Dr. Kortekaas, Dr. Lardenoije, Prof. Dr. Maessen, Dr. Schreurs, Dr. Vissers, Dr. Youssef-El Soud and Prof. Dr. Dijkgraaf have nothing to disclose. Funding Information: This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). Funding Information: This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = aug,

doi = "10.1016/j.lungcan.2019.05.031",

language = "English",

volume = "134",

pages = "52--58",

journal = "Lung Cancer",

issn = "0169-5002",

publisher = "Elsevier Ireland Ltd",

}

Bousema, JE, van Dorp, M, Hoeijmakers, F, Huijbregts, IA, Barlo, NP, Bootsma, GP, van Boven, WJP, Claessens, NJM, Dingemans, AMC, Hanselaar, WE, Kortekaas, RTJ, Lardenoije, JWHP, Maessen, JG, Schreurs, WH, Vissers, Y, Youssef-El Soud, M, Dijkgraaf, MGW, Annema, JT & van den Broek, FJC 2019, 'Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis', Lung Cancer, vol. 134, pp. 52-58. https://doi.org/10.1016/j.lungcan.2019.05.031

TY - JOUR

T1 - Guideline adherence of mediastinal staging of non-small cell lung cancer

T2 - A multicentre retrospective analysis

AU - Bousema, Jelle E.

AU - van Dorp, Martijn

AU - Hoeijmakers, Fieke

AU - Huijbregts, Ilse A.

AU - Barlo, Nicole P.

AU - Bootsma, Gerben P.

AU - van Boven, Wim Jan P.

AU - Claessens, Niels J.M.

AU - Dingemans, Anne Marie C.

AU - Hanselaar, Wessel E.

AU - Kortekaas, Robert Th J.

AU - Lardenoije, Jan Willem H.P.

AU - Maessen, Jos G.

AU - Schreurs, W. Hermien

AU - Vissers, Yvonne

AU - Youssef-El Soud, Maggy

AU - Dijkgraaf, Marcel G.W.

AU - Annema, Jouke T.

AU - van den Broek, Frank J.C.

N1 - Funding Information: Dr. Bousema and Dr. van den Broek report grants from ZonMw and the Dutch Cancer Society, during the conduct of this study. Prof. Dr. Annema reports non-financial support from Hitachi Medical systems and Pentax and a grant from Cook medical, outside the submitted work. Dr. van Dorp, Dr. Hoeijmakers, E. Huijbregts, Dr. Barlo, Dr. Bootsma, Dr. Van Boven, Dr. Claessens, Prof. Dr. Dingemans, Dr. Hanselaar, Dr. Kortekaas, Dr. Lardenoije, Prof. Dr. Maessen, Dr. Schreurs, Dr. Vissers, Dr. Youssef-El Soud and Prof. Dr. Dijkgraaf have nothing to disclose. Funding Information: This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). Funding Information: This retrospective analysis is part of the MEDIASTrial which is funded by ZonMw (project number 843004109) and The Dutch Cancer Society (project number 11313). Publisher Copyright: © 2019 Elsevier B.V.

PY - 2019/8

Y1 - 2019/8

N2 - Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy. Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline. Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed ‘systematically’ in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy. Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.

AB - Objectives: Mediastinal lymph node staging of NSCLC by initial endosonography and confirmatory mediastinoscopy is recommended by the European guideline. We assessed guideline adherence on mediastinal staging, whether staging procedures were performed systematically and unforeseen N2 rates following staging by endosonography with or without confirmatory mediastinoscopy. Material and Methods: We performed a multicentre (n = 6) retrospective analysis of NSCLC patients without distant metastases, who were surgical candidates and had an indication for mediastinal staging in the year 2015. All patients who underwent EBUS, EUS and/or mediastinoscopy were included. Surgical lymph node dissection was the reference standard. Guideline adherence was based on the 2014 ESTS guideline. Results: 330 consecutive patients (mean age 69 years; 61% male) were included. The overall prevalence of N2/N3 disease was 42%. Initial mediastinal staging by endosonography was done in 84% (277/330; range among centres 71-100%; p <.01). Confirmatory mediastinoscopy was performed in 40% of patients with tumour negative endosonography (61/154; range among centres 10%-73%; p <.01). Endosonography procedures were performed ‘systematically’ in 21% of patients (57/277) with significant variability among centres (range 0-56%; p <.01). Unforeseen N2 rates after lobe-specific lymph node dissection were 8.6% (3/35; 95%-CI 3.0-22.4) after negative endosonography versus 7.5% (3/40; 95% CI 2.6-19.9) after negative endosonography and confirmatory mediastinoscopy. Conclusion: Although adherence to the European NSCLC mediastinal staging guideline on initial use of endosonography was good, 30% of endosonography procedures were performed insufficiently. Confirmatory mediastinoscopy following negative endosonography was frequently omitted. Significant variability was found among participating centres regarding staging strategy and systematic performance of procedures. However, unforeseen N2 rates after mediastinal staging by endosonography with and without confirmatory mediastinoscopy were comparable.

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U2 - 10.1016/j.lungcan.2019.05.031

DO - 10.1016/j.lungcan.2019.05.031

M3 - Article

C2 - 31319995

AN - SCOPUS:85066613144

SN - 0169-5002

VL - 134

SP - 52

EP - 58

JO - Lung Cancer

JF - Lung Cancer

ER -

Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis

Abstract

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