ABSTRACT
Lung cancer maintains a dismal prognosis despite diagnostic and therapeutic advancements, with 5-year survival hovering around 16%. The majority of cases are diagnosed at an advanced, incurable stage, contributing significantly to the poor prognosis.
This study investigates whether the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) approach can facilitate early detection of lymph node metastases in non-small cell lung cancer (NSCLC), thereby improving patient selection for surgical intervention.
Data from the Reggio Emilia Cancer Registry, Northern Italy, covering NSCLC incidents from 2017 to 2019, were utilized. Patients were categorized based on diagnostic approach (systematic or selective) and information on stage and treatment was collected. Outcomes, including recurrence and mortality, were assessed.
Among the 68 patients included (47 systematic, 21 selective), no significant differences in sex or age were observed. However, discrepancies were found in stage distribution. The systematic group exhibited fewer stage I (25.5% vs. 47.6%), but more stage II (36.2% vs. 14.3%), while no differences were accounted for stage III (34% vs. 33.3%) and stage IV (4.3% vs. 4.8%). Surgical intervention (74.5% vs. 100%), neoadjuvant chemotherapy (4.3% vs. 14.3%), and adjuvant radiotherapy (17% vs. 28.6%) were less frequent in the systematic group, while adjuvant chemotherapy (42.5% vs. 33.3%) and neoadjuvant radiotherapy (4.3 compared to 0%) were more common. The systematic group showed fewer recurrences (25.5% vs. 52.4%; P-value <0.05), though mortality (59.6% vs. 57.1%) and the disease-free survival (DFS) (40.9% vs 41.2%) rates showed no significant difference.
However, a higher percentage of deaths without recurrence (34.1% vs. 17.6 %) was observed in the systematic group.
Despite the study’s limited sample size, findings suggest a greater sensitivity of the systematic approach in detecting lymph node metastasis and identifying surgical candidates. While the EBUS-TBNA approach appears to influence recurrence rates, its impact on mortality remains inconclusive.

IMPACT STATEMENT
Lung cancer continues to be a disease with a poor prognosis as more than 50% of tumors are diagnosed at an advanced stage. New diagnostic procedures such as EBUS-TBNA (endobronchial ultrasound-guided transbronchial needle aspiration) could facilitate the early diagnosis of lymph node metastases, thus improving the selection of patients who are candidates for surgery. This population-based study appears to be able to confirm the usefulness of this approach.