Browse > Article

The Clinical Value of Mediastinoscopy in Preoperative Staging of Non-small Cell Lung Cancer  

Haam, Seok-Jin (Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine)
Kim, Do-Hyung (Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital, Eulji University College of Medicine)
Jeon, Se-Eun (Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine)
Lee, Doo-Yun (Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine)
Paik, Hyo-Chae (Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine)
Publication Information
Journal of Chest Surgery / v.40, no.11, 2007 , pp. 745-751 More about this Journal
Abstract
Background: Mediastinoscopy is generally performed to confirm mediastinal lymph node metastasis in lung cancer patients. It still remains controversial whether mediastinoscopy should be performed in all patients with resectable non-small cell lung cancer (NSCLC). We studied the clinical value of mediastinoscopy in preoperative staging in NSCLC. Material and Method: We retrospectively studied 90 NSCLC patients who underwent radiological evaluation and mediastinoscopy followed by surgical resection from March 2002 to December 2004. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each evaluation method were assessed and compared. Result: Specificity, PPV, NPV, and accuracy of mediastinoscopy were superior to those of radiological evaluation, but there was no significant difference in sensitivity. The sensitivity of mediastinoscopy was 28.6% in 62 patients with radiological N0/1 disease and 72.7% in 28 patients with radiological N2/3 disease. Seven of eight patients in whom positive nodes were not detected by the mediastinoscopy had subcarinal lymph node metastasis. Conclusion: Considering its invasiveness, the difficulty to reach certain node stations, and its low sensitivity in radiological N0/1 disease, mediastinoscopy should be selectively performed in radiological N2/3 disease rather than in all radiological cancer stages.
Keywords
Carcinoma, non-small cell, lung; Mediastinoscopy;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Induction therapy for non-small cell lung cancer with involved mediastinal nodes in multiple stations. Chest 2000;118:123-8   DOI   ScienceOn
2 Betticher DC, Hsu Schmitz SF, Totsch M, et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial. J Clin Oncol 2003;21:1752-9   DOI   ScienceOn
3 Pearson FG. Staging of the mediastinum. Role of mediastinoscopy and computed tomography. Chest 1993;103: 346S-8S   DOI   ScienceOn
4 Poncelet AJ, Lonneux M, Cochec E, Weynand B, Noirhomme P. Groupe d'Oncologie Thoracique des Cliniques Saint-Luc. PET-FDG scan enhances but does not replace preoperative surgical staging in non-small cell lung carcinoma. Eur J Cardiothorac Surg 2001;20:468-75   DOI   ScienceOn
5 de Langen AJ, Raijmakers P, Riphagen I, Paul MA, Hoekstra OS. The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis. Eur J Cardiothorac Surg 2006;29:26-9   DOI   ScienceOn
6 Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-7   DOI   ScienceOn
7 Gross BH, Glazer GM, Orringer MB, Spizarny DL, Flint A. Bronchogenic carcinoma metastatic to normal-sized lymph nodes: frequency and significance. Radiology 1988; 166:71-4   DOI   PUBMED
8 Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000;343: 254-61   DOI   ScienceOn
9 Jolly PC, Hutchinson CH, Detterbeck F, Guyton SW, Hofer B, Anderson RP. Routine computed tomographic scans, selective mediastinoscopy, and other factors in evaluation of lung cancer. J Thorac Cardiovasc Surg 1991;102:266-70   PUBMED
10 Libshitz HI, McKenna RJ Jr. Mediastinal lymph node size in lung cancer. Am J Roentgenol 1984;143:715-8   DOI   ScienceOn
11 Cybulsky IJ, Lanza LA, Ryan MB, Putnam JB Jr, Mc- Murtrey MM, Roth JA. Prognostic significance of computed tomography in resected N2 lung cancer. Ann Thorac Surg 1992;54:533-7   DOI   PUBMED   ScienceOn
12 Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:833-9
13 Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003;123:137S-46S   DOI   ScienceOn
14 Dillemans B, Deneffe G, Verschakelen J, Decramer M. Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients. Eur J Cardiothorac Surg 1994;8:37-42   DOI   ScienceOn
15 Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s- meta-analytic comparison of PET and CT. Radiology 1999;213:530-6   DOI   PUBMED
16 Hammoud ZT, Anderson RC, Meyers BF, et al. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg 1999;118:894-9   DOI   ScienceOn
17 Fritscher-Ravens A, Davidson BL, Hauber HP, et al. Endoscopic ultrasound, positron emission tomography, and computerized tomography for lung cancer. Am J Respir Crit Care Med 2003;168:1293-7   DOI   ScienceOn
18 Kimura H, Iwai N, Ando S, et al. A prospective study of indications for mediastinoscopy in lung cancer with CT findings, tumor size, and tumor markers. Ann Thorac Surg 2003;75:1734-9   DOI   ScienceOn
19 Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. The world health organizatiion classification of tumours. Tumours of the lung, pleura, thymus and heart. 1st ed. Lyon: IARC Press. 2004;10-1
20 Burfeind WR Jr, Harpole DH Jr. Surgical strategies and outcomes after induction therapy for non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2005;17:186-90   DOI   ScienceOn
21 Toloza EM, Harpole L, Detterbeck F, McCrory DC. Invasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003;123:157S-66S   DOI   ScienceOn
22 Libshitz HI, McKenna RJ Jr, Haynie TP, McMurtrey MJ, Mountain CT. Mediastinal evaluation in lung cancer. Radiology 1984;151:295-9   DOI   PUBMED
23 Seely JM, Mayo JR, Miller RR, Muller NL. T1 lung cancer: prevalence of mediastinal nodal metastases and diagnostic accuracy of CT. Radiology 1993;186:129-32   DOI   PUBMED