The value of Mediastinoscopy in Preoperative
Evaluation of Mediastinal Involvement in Non-Small-Cell Lung Cancer Patients with Clinical NO Disease

 

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Abstract

Background: The efficacy of mediastinal lymph node examination using cervical mediastinoscopy in operable non-small cell lung cancer patients without radiological nodal involvement on computerized tomography (CT) has been elusive. Methods: The value of mediastinoscopy as a staging modality for assessing the mediastinal lymph node status was evaluated in 79 patients with presumed resectable non-small-cell lung cancer (NSCLC) with mediastinal nodes smaller than 1 cm (NO) form the CT scan. Sixty-one patients who did not have nodal involvement at mediastinoscopy and had complete medical records underwent complete resection. Results: Negative predictive value (NPV) of the CT scan according to mediastinoscopy was 92.4 %. Histopathological examination of the surgical specimen showed the NPV of mediastinoscopy to be 93.4 %. Only 4 patients (3 patients with N2, 1 patient with N3 disease) were not correctly staged using CT scanning and mediastinoscopy. According to the pathological examination, the NPV of CT was found to be lower (76.5 %) in patients with adenocarcinoma, but the difference was not statistically significant (p > 0.128) Conclusion: Although the likelihood of surgical-pathological N2 is slightly higher in patients with adenocarcinoma, radiological examination of patients with cNO NSCLC disease can be as accurate as mediastinoscopy in appropriately staging mediastinal lymph node involvement.

References

• 1 Liewald F, Grosse S, Storck M. et al . How useful is positron emission tomography for lymph node staging in non-small-cell lung cancer?.  Thorac Cardiovasc Surg. 2000;  48 93-96
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Chin R, Keyes J W. et al . Mediastinal staging of non-small cell lung cancer with positron emission tomography.  Am J Repir Crit Care Med. 1995;  152 2090-2096
  PubMedGoogle Scholar
• 3 Ginsberg R J. Evaluation of the mediastinum by invasive techniques.  Surg Clin North Am. 1987;  67 1025-1035
  PubMedGoogle Scholar
• 4 Pearson F G. Current status of surgical resection for lung cancer.  Chest. 1994;  106 337S-339S
  PubMedGoogle Scholar
• 5 Suzuki K, Nagai K, Yoshida J. et al . Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer.  J Thorac Cardiovasc Surg. 1999;  117 593-598
  CrossrefPubMedGoogle Scholar
• 6 Daly B D, Mueller J D, Falling L J. et al . N2 lung cancer: Outcome in patients with false-negative computed tomographic scans of the chest.  J Thorac Cardiovasc Surg. 1993;  105 904-910
  PubMedGoogle Scholar
• 7 Khan A, Gersten K C, Garvey J. et al . Oblique hilar tomography, computed tomography, and mediastinoscopy for prethoracotomy staging of bronchogenic carcinoma.  Radiology. 1985;  156 295-298
  PubMedGoogle Scholar
• 8 Backer C L, Shields T W, Lockhart C G. et al . Selective preoperative evaluation for possible N2 disease hi carcinoma of the lung.  J Thorac Cardiovasc Surg. 1987;  93 337-343
  PubMedGoogle Scholar
• 9 Webb W R, Gatsonis C, Zerhouni E A. et al . CT and MR imaging in staging non-small cell bronchogenic carcinoma: Report of the Radiologic Diagnostic Oncology Group.  Radiology. 1991;  178 705-713
  CrossrefPubMedGoogle Scholar
• 10 Rhoads A C, Thomas J H, Hermreck A S. et al . Comparative studies of computerized tomography and mediastinoscopy for the staging of bronchogenic carcinoma.  Am J Surg. 1986;  152 587-591
  CrossrefPubMedGoogle Scholar
• 11 Aronchick J M. CT of mediastinal lymph nodes in patients with non-small cell lung carcinoma.  Radiol Clin North Am. 1990;  28 573-581
  PubMedGoogle Scholar
• 12 World Health Organization .Histological typing of lung tumors. Geneva: World Health Organization 1981 2
  Google Scholar
• 13 Mountain C F. Revisions hi the international system for staging lung cancer.  Chest. 1997;  111 1710-1717
  CrossrefPubMedGoogle Scholar
• 14 Martini N, Flehinger B J. The role of surgery in N2 lung cancer.  Surg Clin North Am. 1987;  67 279-285
  PubMedGoogle Scholar
• 15 Goldstraw P, Kurzer M, Edwards D. Preoperative staging of lung cancer: Accuracy of computed tomography vs. mediastinoscopy.  Thorax. 1983;  38 10-15
  PubMedGoogle Scholar
• 16 Pearson F G. Staging of mediastinum. Role of mediastinoscopy and computed tomography.  Chest. 1993;  103 346S-348S
  PubMedGoogle Scholar
• 17 Gdeedo A, van Schil P, Corthouts B. et al . Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging.  Eur Respir J. 1997;  10 1547-1551
  CrossrefPubMedGoogle Scholar
• 18 Khan A, Khan F A, Garvey J. et al . Oblique hilar tomography and mediastinoscopy. A correlative prospective study in 100 patients with bronchogenic carcinoma.  Chest. 1984;  86 424-429
  PubMedGoogle Scholar
• 19 Tsang G MK, Watson D CT. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer.  Thorax. 1992;  47 3-5
  CrossrefPubMedGoogle Scholar
• 20 Little A G, Dehoyos A, Kirgan D M. et al . Intraoperative lymphatic mapping for non-small cell lung cancer: The sentinel node technique.  J Thorac Cardiovasc Surg. 1999;  117 220-224
  PubMedGoogle Scholar

1 Presented at the 8^th European Conference on General Thoracic Surgery, London, 1st - 3rd November, 2000

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