Anterior and cervical mediastinoscopy for determining operability and predicting resectability in lung cancer

Jolly, Philip C.; Li, Wei-i; Anderson, Richard P.

doi:10.1016/s0022-5223(19)37945-0

Cited by 46 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mediastinoscopy has been widely employed during the last 25 years as a diagnostic method for investigating the superior mediastinum. The attitude to mediastinoscopy varies a great deal in different countries and even in different hospitals (Carlens, 1959;Carlens and Hambraueus, 1967;Lincoln and Provan, 1970;Inberg et al, 1972;Otto etal, 1972;Preciado etal, 1973;Ashraf et al, 1980;Jolly et al, 1980;Pearson et al, 1982;Coughlin et al, 1985;Rubinstein and Baum, 1986). Many clinicians consider mediastinoscopy a dangerous procedure.…”

Section: Introductionmentioning

confidence: 99%

Complications of mediastinoscopy

Puhakka

1989

J. Laryngol. Otol.

View full text Add to dashboard Cite

From 1968 to 1987, mediastinoscopy was performed on 2021 consecutive patients. The procedure was carried out in 35.7 per cent on patients with a pulmonary infiltrate and in 28.8 per cent with bronchogenic carcinoma. Mediastinoscopy was positive in 54 per cent of the cases. The total number of complications was 2.3 per cent (47/2021). There were four cases with major haemorrhage, three tracheal ruptures and three wound infections. Recurrent nerve paralysis was verified in three patients and pericardial rupture in two patients. The total of major complications was 0.5 per cent (10/2021). There was no deaths in this series. In the authors' opinion, mediastinoscopy can be regarded as an effective and safe procedure in the hands of an experienced surgeon.

show abstract

Section: Introductionmentioning

confidence: 99%

Complications of mediastinoscopy

Puhakka

1989

J. Laryngol. Otol.

View full text Add to dashboard Cite

show abstract

“…Summary measures of test performance from pooled studies are not available for mediastinoscopy. Nonetheless, sensitivity and specificity can be deduced from a number of studies, [1][2][3][4]8,9 some of which are summarized in Table 3. Table 3 contains a representative sample of methodologically sound studies; the table is not meant to provide an exhaustive survey of the literature.…”

Section: Test Performance Datamentioning

confidence: 99%

Strategies for Test Selection in the Staging of Lung Neoplasms

Owens¹,

Sox²,

Inouye³

1989

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Although several strategies have been proposed for the staging of lung neoplasms, there is still considerable disagreement as to the appropriate use of mediastinoscopy, computed tomography (CT), standard tomography (ST), and magnetic resonance imaging (MRI). We believe the disagreement is in part related to two problems. First, data on test performance have been inaccurate, inconsistent, or unavailable. Second, the implications of pretest probability and test performance on post-test probability have not been explicitly considered when test selection recommendations have been formulated.In this article we first discuss general concepts of test interpretation derived from Bayes' theorem. We then review test performance data for CT, ST, and mediastinoscopy and present general guidelines for test selection that can be applied to any proposed strategy for lung cancer staging. IMPORTANT CONCEPTUAL LESSONS FROM BAYES' THEOREMOf the possible tests one can consider for staging or diagnosis of lung cancer, all are imperfect. That is, both false-positive and false-negative test results occur. Even mediastinoscopy has a significant falsenegative rate. 1-4 Thus, one cannot know the patient's true state with certainty; intelligent test interpretation requires the use of probability.Bayes' theorem is a straightforward algebraic expression that allows calculation of the post-test probability of disease if the pretest probability, test sensitivity and specificity are known (see Appendix). A number of important lessons follow from an understanding of the rule:1. The pretest probability of disease has a dramatic effect on the post-test probability. Figure 1 illustrates the post-test probability of mediastinal metastases after a positive CT scan. In panel A, the pretest probability is 0.1, and the sensitivity and specificity are 0.74 and 0.79, respectively. 5 Recall that the sensitivity of a test represents the probability that a diseased patient will have a positive test; specificity denotes the probability that a nondiseased patient will have a negative test. The posttest probability, calculated with Bayes' theorem, is 0.28, as shown in the figure. In panel B, the calculation is repeated using identical sensitivity and specificity data, but with a pretest probability of 0.5. Note the post-test probability is now 0.78, considerably higher than before. In each case, the CT scan is "positive," but the post-test probability of disease is very different in the two situations. This example illustrates the importance of pretest probability: rational test interpretation is virtually impossible if one cannot estimate, at least roughly, the pretest probability. 2. The sensitivity (also called the true-positive rate) of a test primarily affects the interpretation of a negative result. In Figure 2 panel A shows the post-test probability of disease after positive and negative CT scans, calculated for a pretest probability of 0.50. The sensitivity and specificity are each 0.75. Sensitivity is defined as the probability that a dis-

show abstract

Accuracy of chest computerized tomography in detecting malignant hilar and mediastinal involvement by squamous cell carcinoma of the lung

Frederick

Bernardino

Baron

et al. 1984

Cancer

View full text Add to dashboard Cite

The accuracy of chest computerized tomography (CT) in detecting malignant hilar and mediastinal involvement by squamous cell carcinoma of the lung is examined. The preoperative chest CT scans of 74 patients with pathologically proven squamous cell lung carcinoma were prospectively and retrospectively reviewed. Criteria for the diagnosis of malignant hilar involvement were nonvascular mass enlarging the hilum; local alteration of hilar contour; adenopathy greater than 1 cm; thickened posterior wall of the bronchus intermedius and distal upper lobe bronchi; and bronchial displacement, compression, and obstruction. Criteria for the diagnosis of malignant mediastinal involvement were confluence of tumor with the mediastinum, altered contour of the azygoesophageal recess, thickened posterior wall of the proximal main stem bronchi, and mediastinal adenopathy greater than 1 cm. Calcified hilar and mediastinal nodes were considered benign. Our results, corrected for reader error, were 92% sensitive, 92% specific, and 96% accurate in the hilum and 95% sensitive, 77% specific, and 82% accurate in the mediastinum. These data support a significant role for chest CT in the preoperative staging of non small cell lung carcinoma.

show abstract

Anterior and cervical mediastinoscopy for determining operability and predicting resectability in lung cancer

Cited by 46 publications

References 17 publications

Complications of mediastinoscopy

Complications of mediastinoscopy

Strategies for Test Selection in the Staging of Lung Neoplasms

Accuracy of chest computerized tomography in detecting malignant hilar and mediastinal involvement by squamous cell carcinoma of the lung

Contact Info

Product

Resources

About