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Assessment of Surgical sTaging vs Endoscopic Ultrasound in Lung Cancer: a Randomized Clinical Trial (ASTER Study)

This study has been completed.
Leiden University Medical Center
Information provided by:
University Hospital, Ghent Identifier:
First received: February 7, 2007
Last updated: December 15, 2010
Last verified: December 2010

Lung cancer is one of the most prevalent cancers and has a very high mortality. Both treatment and prognosis depend on the staging. Surgical staging of the mediastinum mainly by means of a cervical mediastinoscopy is the gold standard. Mediastinal staging is however a field that undergoes a fast technological development. Transesophageal ultrasound guided fine-needled aspiration (EUS-FNA) and an endobronchial ultrasound guided transbronchial fine-needled aspiration (EBUS-TBNA) are two complementary endoscopic ultrasound techniques which together allow cytological analysis of all mediastinal lymph nodes. This means that the combination of both techniques enables a complete (bilateral) mediastinal investigation (N2 and N3, except para-aortal station 6).

Hypothesis: complete endoscopic ultrasound staging identifies more patients with locally advanced disease compared to surgical staging (current standard of care).

Study design: A randomized controlled multi-center double arm diagnostic phase III trial, in which patients are randomly assigned to either surgical staging (arm B) or endoscopic ultrasound staging with both EUS-FNA and EBUS-TBNA (arm A).

Arm A: Examination by EUS-FNA and EBUS-TBNA. These techniques are performed in an outpatient one session setting under conscious sedation and take together about 30 to 60 minutes. If no metastasis are shown, the patient undergoes a surgical staging procedure (for confirmation). For reasons of convenience and patient-comfort, the EUS-FNA investigation is performed before the EBUS-TBNA.

Arm B: Surgical staging with either cervical mediastinoscopy, parasternal mediastinoscopy, thorascopic mediastinal exploration or exploratory thoracotomy, performed according to institutional practice.

Patients in whom no lymph node metastasis are found proceed to thoracotomy with systematic lymph node sampling to obtain an accurate intraoperative mediastinal staging.

Primary outcome: The assessment of N2-N3 lymph node metastases.

Condition Intervention
Carcinoma, Non-Small-Cell Lung
Procedure: Endoscopic ultrasound staging
Procedure: Surgical staging

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: Complete Echo-Endoscopic Staging of Lung Cancer vs Surgical Staging: a Randomized Clinical Trial

Resource links provided by NLM:

Further study details as provided by University Hospital, Ghent:

Primary Outcome Measures:
  • We hypothesize that the combination of EUS and EBUS in an out-patient one-session setting is more sensitive for the detection of locally advanced disease (N2/N3) compared to surgical staging (standard of care)

Secondary Outcome Measures:
  • Assessment of mediastinal tumour invasion (T4)
  • Assessment of the rate of avoided surgical procedures (arm A)
  • Assessment of the negative predictive value
  • Assessment of the difference in the cost for lymph node staging
  • Assessment of the complication rates
  • Assessment of the rate of futile thoracotomies
  • Assessment of quality of life (EQ5D)

Enrollment: 240
Study Start Date: January 2007
Study Completion Date: April 2009
Primary Completion Date: April 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Endoscopic ultrasound staging
Procedure: Endoscopic ultrasound staging
Endoscopic ultrasound staging with both EUS-FNA and EBUS-TBNA
Active Comparator: 2
Surgical staging
Procedure: Surgical staging
Surgical staging


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Consecutive patients with NSCLC or with a clinical suspicion for lung cancer in whom mediastinal lymph node invasion (either N2 or N3) is suspected based on the available thoracic imaging
  • Pending the results of the mediastinal staging, the patient is otherwise considered a candidate for a surgical treatment with the intention to cure (this is a resectable tumor)
  • The patient is clinically fit for diagnostic surgery (this is an operable patient)
  • No distant metastasis after routine clinical work up
  • Provision of a written informed consent

Exclusion Criteria:

  • Former therapy (chemotherapy or radiotherapy or surgery) for lung cancer
  • Reasons because of which the patient is unable to swallow the EUS-instrument (e.g. Zenker Divertikel, unexplained esophageal stenosis) or because of which the patient is unable to undergo a bronchoscopy
  • Patients who, based on available thoracic imaging, are unlikely to be staged accurately by any surgical staging procedure (mediastinoscopy/ - tomy, VATS)
  • Respiratory insufficiency or other contra-indications for bronchoscopy
  • Concurrent other malignancies
  • Uncorrected coagulopathy
  • Study cannot be discussed with the patient (e.g. mental disorder)
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Please refer to this study by its identifier: NCT00432640

University Hospital Ghent
Ghent, Belgium, 9000
Leuven University Hospital
Leuven, Belgium, 3000
Leidens Universitair Medisch Centrum (LUMC)
Leiden, Netherlands
United Kingdom
Papworth University Hospital
Cambridge, United Kingdom
Sponsors and Collaborators
University Hospital, Ghent
Leiden University Medical Center
Principal Investigator: Kurt Tournoy, MD, PhD University Hospital, Ghent
Principal Investigator: Jouke Annema, MD Leidens Universitair Medisch Centrum
  More Information

Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Kurt Tournoy, MD, PhD, University Hospital Ghent Identifier: NCT00432640     History of Changes
Other Study ID Numbers: 2006/461
Study First Received: February 7, 2007
Last Updated: December 15, 2010

Keywords provided by University Hospital, Ghent:
(suspected) Non Small Cell Lung Cancer

Additional relevant MeSH terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms processed this record on April 26, 2017