据11月24日刊《美国医学会杂志》上的一项研究披露，比较2种确定疑似非小细胞型肺癌（NSCLC）病期的策略发现，创伤性较小的那种方法对辨识某种已经扩散的肺癌更为有效，这种方法可能会减少某些病人中的非必要的外科手术及其相关的不良反应。
肺癌是全世界最常被诊断的癌症（每年有135万人被诊断患有肺癌）；肺癌也是最常见的癌症死亡原因（每年有120万人死于肺癌）。根据文章的背景资料，确定癌症病期是治疗病人的一个重要的部分，因为癌症分期对治疗具有指导作用并对预后有价值。但是通过手术来确定癌症病期有局限性，而且还会导致不必要的开胸术（即切开胸廓），而开胸术可能导致手术后患者健康的显着损害及更高的死亡风险。
目前的肺癌分期指南确认超声内镜成像（用光纤内窥镜对内脏进行超声波检查）是一种用外科进行癌症分期来发现淋巴结病（收集病变组织）的微创性备选方法 （如果超声内镜成像没有发现淋巴结转移的话再采用手术癌症分期）。纵隔（即肺附近的胸腔内空间）组织的癌症分期常常是由纵隔镜检查的方法来进行的，这是一种外科诊断方法。文章的作者写道：“目前人们还不知道，起初用超声内镜成像方法来对纵隔组织肺癌进行分期是否会提高淋巴结肺癌转移的发现率，以及降低不必要的开胸术的发生率 。”
荷兰莱顿的莱顿大学医疗中心的Jouke T. Annema, M.D., Ph.D.及其同事对仅用外科癌症分期相对于超声内镜成像的方法（也就是将经食道及支气管内超声波相结合）加上随后的外科癌症分期法进行了比较。这一随机对照的多中心试验是在2007年2月至2009年4月间进行的，其中有241位患者罹患可切除的（疑似）NSCLC；根据计算机或正电子发射断层摄影（这些都是成像技术），这些患者具有做纵隔分期的指针。这些病人或是接受外科癌症分期或是接受超声内镜成像法加上外科癌症分期（如果在超声内镜成像检查中没有发现淋巴结癌症转移的话）。在没有纵隔肿瘤转移的证据的情况下，病人将接受开胸术加上淋巴结切割术。
文章的作者写道：“我们证明，在罹患可切除的NSCLC病人中，以超声内镜成像法来开始纵隔淋巴结癌症分期大大提高了淋巴结癌症转移的检测率；并且，与仅用外科癌症分期的方法相比，不必要的开胸术发生率降低了50%以上。此外，超声内镜成像法不需要做全身麻醉，它是患者的首选方法。与外科癌症分期相比，它被认为是成本效益高的方法。”
研究人员补充说，鉴于超声内镜成像法的敏感性与纵隔镜类似（分别为85% vs. 79%）及超声内镜成像法的并发症发生率较低（为1%，而纵隔镜的并发症发生率为6%），超声内镜成像检查应该成为纵隔淋巴结癌症分期的第一个步骤。（生物谷Bioon.com）
生物谷推荐英文摘要：
JAMA. 2010;304(20):2245-2252. doi:10.1001/jama.2010.1705
Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer
Jouke T. Annema, MD, PhD; Jan P. van Meerbeeck, MD, PhD; Robert C. Rintoul, FRCP, PhD; Christophe Dooms, MD, PhD; Ellen Deschepper, PhD; Olaf M. Dekkers, MA, MD, PhD; Paul De Leyn, MD, PhD; Jerry Braun, MD; Nicholas R. Carroll, FRCP, FRCR; Marleen Praet, MD, PhD; Frederick de Ryck, MD; Johan Vansteenkiste, MD, PhD; Frank Vermassen, MD, PhD; Michel I. Versteegh, MD; Maud Veseli?, MD; Andrew G. Nicholson, FRCPath, DM; Klaus F. Rabe, MD, PhD; Kurt G. Tournoy, MD, PhD
Context Mediastinal nodal staging is recommended for patients with resectable non–small cell lung cancer (NSCLC). Surgical staging has limitations, which results in the performance of unnecessary thoracotomies. Current guidelines acknowledge minimally invasive endosonography followed by surgical staging (if no nodal metastases are found by endosonography) as an alternative to immediate surgical staging.
Objective To compare the 2 recommended lung cancer staging strategies.
Design, Setting, and Patients Randomized controlled multicenter trial (Ghent, Leiden, Leuven, Papworth) conducted between February 2007 and April 2009 in 241 patients with resectable (suspected) NSCLC in whom mediastinal staging was indicated based on computed or positron emission tomography.
Intervention Either surgical staging or endosonography (combined transesophageal and endobronchial ultrasound [EUS-FNA and EBUS-TBNA]) followed by surgical staging in case no nodal metastases were found at endosonography. Thoracotomy with lymph node dissection was performed when there was no evidence of mediastinal tumor spread.
Main Outcome Measures The primary outcome was sensitivity for mediastinal nodal (N2/N3) metastases. The reference standard was surgical pathological staging. Secondary outcomes were rates of unnecessary thoracotomy and complications.
Results Two hundred forty-one patients were randomized, 118 to surgical staging and 123 to endosonography, of whom 65 also underwent surgical staging. Nodal metastases were found in 41 patients (35%; 95% confidence interval [CI], 27%-44%) by surgical staging vs 56 patients (46%; 95% CI, 37%-54%) by endosonography (P = .11) and in 62 patients (50%; 95% CI, 42%-59%) by endosonography followed by surgical staging (P = .02). This corresponded to sensitivities of 79% (41/52; 95% CI, 66%-88%) vs 85% (56/66; 95% CI, 74%-92%) (P = .47) and 94% (62/66; 95% CI, 85%-98%) (P = .02). Thoracotomy was unnecessary in 21 patients (18%; 95% CI, 12%-26%) in the mediastinoscopy group vs 9 (7%; 95% CI, 4%-13%) in the endosonography group (P = .02). The complication rate was similar in both groups.
Conclusions Among patients with (suspected) NSCLC, a staging strategy combining endosonography and surgical staging compared with surgical staging alone resulted in greater sensitivity for mediastinal nodal metastases and fewer unnecessary thoracotomies.
