Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.

McLoud, Theresa C.; Bourgouin, Pierre; Greenberg, Rona W.; Kosiuk, John; Templeton, Philip A.; Shepard, Jo Anne O.; Moore, Elizabeth Hernández; Wain, John C.; Mathisen, Douglas J.; Grillo, Hermes C.

doi:10.1148/radiology.182.2.1732943

Cited by 522 publications

(181 citation statements)

References 0 publications

Supporting

Mentioning

164

Contrasting

Unclassified

Order By: Relevance

“…However, in 1992 MCLOUD et al [108] using a nodal short axis measurement of 1 cm in 143 patients, returned to less inspiring figures of 64% sensitivity and 62% specificity, respectively. These studies [105,106,108] all examined patients with presumed operable lung cancer in whom complete nodal sampling was performed either at mediastinoscopy or thoracotomy. Both LIBSHITZ and MCKENNA [105] and MCLOUD et al [108] observed an increase in false-positive nodes in patients with obstructive pneumonia.…”

Section: Nodal Statusmentioning

confidence: 97%

“…A meta-analysis in 1990 of 42 CT studies assessing mediastinal lymph node metastases from NSCLC described an overall sensitivity of 0.79, a specificity of 0.78 and an accuracy of 0.79 [107]. However, in 1992 MCLOUD et al [108] using a nodal short axis measurement of 1 cm in 143 patients, returned to less inspiring figures of 64% sensitivity and 62% specificity, respectively. These studies [105,106,108] all examined patients with presumed operable lung cancer in whom complete nodal sampling was performed either at mediastinoscopy or thoracotomy.…”

Section: Nodal Statusmentioning

confidence: 99%

“…These studies [105,106,108] all examined patients with presumed operable lung cancer in whom complete nodal sampling was performed either at mediastinoscopy or thoracotomy. Both LIBSHITZ and MCKENNA [105] and MCLOUD et al [108] observed an increase in false-positive nodes in patients with obstructive pneumonia. MCLOUD et al [103] also found that 37% of nodes, which were 2-3 cm in diameter, did not contain metastases at thoracotomy.…”

Section: Nodal Statusmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

121

View full text Add to dashboard Cite

Carcinoma of the bronchus is the most common malignancy in the Western world. It is also the leading cause of cancer-related death accounting for 32% of all cancer deaths in males and 25% in females [1]. In the USA it causes more deaths than cancers of the colon, breast and prostate combined [2]. Disappointingly, in a recent UK survey of improvements in cancer survival [3], carcinoma of the bronchus showed the smallest percentage reduction in the number of deaths avoided between 1981-1990 (0.2%). This compares badly with breast (11% reduction) and melanoma (32%). The overall 5-yr survival for lung cancer diagnosed between 1986-1990 was only 5.3% (against 66% for breast and 76% for melanoma). It is on this background that the radiologist remains actively employed in the detection, diagnosis, staging and review of this common malignancy.

show abstract

Section: Nodal Statusmentioning

confidence: 97%

Section: Nodal Statusmentioning

confidence: 99%

Section: Nodal Statusmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

121

View full text Add to dashboard Cite

show abstract

“…The reported sensitiv ity of mediastinal lymph node staging by CT scan is ap proximately 60-80% [4, 9,13,19]. It is to be expected that modern CT scanning techniques, with the addition of intra venous contrast studies, will indicate whether a patient could benefit from a cervical mediastinoscopy or a para sternal procedure [7,16].…”

Section: Discussionmentioning

confidence: 99%

The value of parasternal mediastinoscopy in staging bronchial carcinoma

Barendregt

Deleu²,

Joosten³

et al. 1995

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Abstract. Computed tomography (CT) is the non-invasive staging procedure of choice for assessment of metas tasis to mediastinal lymph nodes in patients with bronchial carcinoma. Cervical mediastinoscopy can provide his tologic evidence of mediastinal spread to the peritracheal, tracheobronchial and subcarinal lymph nodes. Subaortic and para-aortic nodes cannot be sampled via this route. The present study was performed to assess the staging value of the parasternal mediastinoscopy as a separate entity. Cervical and parasternal mediastinoscopy was performed in 37 patients with a proven diagnosis of non-small cell carcinoma of the left upper lobe. In 16 pa tients lymph node or tumor tissue could be biopsied via the parasternal route, in 21 patients no parasternal bi opsy was taken. Of the 16 cases with biopsies, only one was positive (6%). Histologic examination of lymph node biopsy tissue was false negative in one other patient (6%). Of the 21 patients without biopsies taken during par asternal mediastinoscopy, three (14%) had proven lymphogenic spread to the subaortic and para-aortic nodes, detected at thoracotomy. The parasternal procedure changed treatment in only one patient (3%). Diagnostic sen sitivity was 20%. It is concluded that parasternal mediastinoscopy should not be used as a routine staging proce dure in patients with left upper lobe lung cancer. [Eur J Cardio-thorac Surg (1995) 9: 655-658] Key words: Parasternal -Mediastinoscopy -Lung cancerThe value of mediastinoscopy in the preoperative assessment of bronchial carcinoma is a subject of ongoing dis cussion. Cervical mediastinoscopy should be used for stag ing in the case of a so-called positive computed tomogra phy (CT) scan (mediastinal lymph nodes of 1.5 cm diam eter or larger, or a group of nodes each 1.0 cm or larger) [4J. Histologic evidence of mediastinal metastasis is man datory in all cases of enlarged nodes on CT scan.The value of parasternal (anterior) mediastinoscopy or mediastinotomy has been discussed in only a few recent publications [1, 4, 5,8,11,14]. In many instances no dif ference is made between the staging value of the cervical and the parasternal procedure. Due to the route of lympho genic spread, the parasternal mediastinoscopy is supposed to be important in the preoperative assessment of left upper lobe tumors [3,10,15]. The benefit of cervical mediasti noscopy is limited to patients with central mediastinal in volvement. Parasternal mediastinotomy is an alternative procedure, but is apparently more invasive than mediasti noscopy. The extended cervical mediastinoscopy, as ad vocated by Ginsberg, is not practised by many surgeons [1]. In some institutes the attitude towards mediastinos copy in general, and towards parasternal mediastinoscopy in particular, appears to have changed. This is partly due to the development of improved CT imaging techniques, which show mediastinal structures with a higher defini tion than 5 or 10 years ago, In order to reassess the value of the staging of lympho genic spread of bronchial carcinoma b...

show abstract

“…CT is the most commonly used noninvasive staging method of the mediastinum, but is far from satisfying and less accurate than invasive surgical staging [51][52][53][54]. In prospective data from the Radiological Diagnostic Oncology Group, the sensitivity and specificity of thoracic CT were only 52% and 69% [55].…”

Section: Locoregional Lymph Node Stagingmentioning

confidence: 99%

Imaging in lung cancer: positron emission tomography scan

Vansteenkiste¹

2002

European Respiratory Journal

View full text Add to dashboard Cite

In the past 5 yrs, positron emission tomography (PET), usually used with 18 F-fluoro-2-deoxy-glucose (FDG), has become an important imaging modality in lung cancer patients.Currently, the use of FDG-PET in respiratory oncology is mainly for diagnosis and staging. Standard indications are the evaluation of an indeterminate solitary pulmonary nodule or mass, where FDG-PET has proven to be significantly more accurate than computed tomography (CT) in the distinction between benign and malignant lesions. Several studies have also convincingly demonstrated that locoregional lymph node staging by FDG-PET (in correlation with CT images) is significantly superior to CT, with a negative predictive value equal or even superior to mediastinoscopy. FDG-PET also improves extrathoracic staging, through the detection of lesions missed at conventional imaging or characterization of lesions that remain equivocal on conventional imaging. Many European countries now have or plan reimbursement in these indications. Large-scale randomized studies should now focus on the impact this accurate tumour imaging technique has on treatment outcome and cost-efficacy.Ongoing studies in specialized centres focus on the use of FDG-PET in more advanced clinical applications, such as planning radiotherapy, response evaluation after radiotherapy or (induction) chemotherapy, follow-up and early detection of recurrence, and prognostic information in this in vivo measurement of tumour glucose metabolism.After a short note on the technique used and a summary of the current common indications of diagnosis and staging, this paper will deal mainly with two of the more advanced clinical applications of FDG-PET in locally advanced nonsmall cell lung cancer: radiation treatment planning and assessment of induction chemotherapy.Finally, it should be mentioned that a whole new field of applications of positron emission tomography in molecular biology, using new radiopharmaceutical probes, is under extensive investigation. These techniques are promising for future use in very early response monitoring during chemo-or radiotherapy, in evaluation of novel molecular-targeted lung cancer therapies, or even gene therapy.

show abstract

Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.

Cited by 522 publications

References 0 publications

Diagnostic imaging of lung cancer

Diagnostic imaging of lung cancer

The value of parasternal mediastinoscopy in staging bronchial carcinoma

Imaging in lung cancer: positron emission tomography scan

Contact Info

Product

Resources

About