Current Concepts in the Mediastinal Lymph Node Staging of Nonsmall Cell Lung Cancer

Kramer, Henk; Groen, Harry J.M.

doi:10.1097/01.sla.0000081086.37779.1a

Cited by 95 publications

(69 citation statements)

References 94 publications

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“…EUS-FNA is a safe, less invasive alternative to mediastinoscopy, which is also complimentary, offering access to nodal stations that a single surgical approach would find more difficult to access [11,[17][18][19]. While EUS-FNA has not been directly compared with transbronchial FNA, the latter has recognised limitations, being only 50-70% sensitive and 92-100% specific in assessing malignant mediastinal lymph node involvement in NSCLC and carrying a complication rate of 2-5% [20,21]. The suitability of EUS-FNA for staging of NSCLC is further highlighted by the lack of PET centres in Australia and overseas, requiring many clinicians to perform more invasive mediastinoscopy to histologically prove stage III disease.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Caddy

Conron²,

Wright³

et al. 2005

European Respiratory Journal

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Optimal management of nonsmall cell lung cancer (NSCLC) depends on tissue diagnosis and accurate staging. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is minimally invasive and provides cytological confirmation of malignant mediastinal disease. The aim was to assess the accuracy of EUS-FNA in cases of enlarged mediastinal lymphadenopathy (LN) of unknown aetiology and in the staging of NSCLC.A total of 52 consecutive patients with stage I-IIIb NSCLC or enlarged mediastinal LN of unknown aetiology underwent EUS-FNA. Negative results were confirmed with a surgical procedure: mediastinoscopy, video-assisted thoracic surgery (VATS) or lobectomy with systematic mediastinal lymph node dissection.In total, 34 patients had EUS-FNA performed for diagnosis, whilst the remaining 18 had EUS-FNA for staging. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (95% confidence interval) were 93% (77-99), 100% (78-100), 100% (87-100), 88% (63-99) and 95% (84-99), respectively. When EUS-FNA was used in patients with NSCLC, the sensitivity, specificity, PPV, NPV and accuracy were 92% (73-99), 100% (69-100), 100% (85-100), 83% (51-98) and 94% (80-99), respectively. For mediastinal LN of unknown aetiology, no malignant disease was missed.Endoscopic ultrasound-guided fine-needle aspiration is an accurate tool for assessing mediastinal lymph node involvement in nonsmall cell lung cancer and in the diagnosis of unexplained mediastinal lymphadenopathy. Endoscopic ultrasound-guided fine-needle aspiration is a minimally invasive procedure that can be used as an adjunct or alternative to mediastinoscopy.

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Section: Discussionmentioning

confidence: 99%

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Caddy

Conron²,

Wright³

et al. 2005

European Respiratory Journal

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“…25 We thus compared the segmentation performance for both small and large lymph nodes in Table II. Small lymph nodes are defined as having longest diameter less than 1 cm, while large nodes have longest diameter greater than 1 cm.…”

Section: Resultsmentioning

confidence: 99%

Automated temporal tracking and segmentation of lymphoma on serial CT examinations

Greenspan

Napel

et al. 2011

Medical Physics

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Purpose: It is challenging to reproducibly measure and compare cancer lesions on numerous follow-up studies; the process is time-consuming and error-prone. In this paper, we show a method to automatically and reproducibly identify and segment abnormal lymph nodes in serial computed tomography (CT) exams. Methods: Our method leverages initial identification of enlarged (abnormal) lymph nodes in the baseline scan. We then identify an approximate region for the node in the follow-up scans using nonrigid image registration. The baseline scan is also used to locate regions of normal, non-nodal tissue surrounding the lymph node and to map them onto the follow-up scans, in order to reduce the search space to locate the lymph node on the follow-up scans. Adaptive region-growing and clustering algorithms are then used to obtain the final contours for segmentation. We applied our method to 24 distinct enlarged lymph nodes at multiple time points from 14 patients. The scan at the earlier time point was used as the baseline scan to be used in evaluating the follow-up scan, resulting in 70 total test cases (e.g., a series of scans obtained at 4 time points results in 3 test cases). For each of the 70 cases, a "reference standard" was obtained by manual segmentation by a radiologist. Assessment according to response evaluation criteria in solid tumors (RECIST) using our method agreed with RECIST assessments made using the reference standard segmentations in all test cases, and by calculating node overlap ratio and Hausdorff distance between the computer and radiologist-generated contours. Results: Compared to the reference standard, our method made the correct RECIST assessment for all 70 cases. The average overlap ratio was 80.7 6 9.7% s.d., and the average Hausdorff distance was 3.2 6 1.8 mm s.d. The concordance correlation between automated and manual segmentations was 0.978 (95% confidence interval 0.962, 0.984). The 100% agreement in our sample between our method and the standard with regard to RECIST classification suggests that the true disagreement rate is no more than 6%. Conclusions: Our automated lymph node segmentation method achieves excellent overall segmentation performance and provides equivalent RECIST assessment. It potentially will be useful to streamline and improve cancer lesion measurement and tracking and to improve assessment of cancer treatment response.

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“…Clinical data revealed that CT itself is not sufficient to identify mediastinal lymph node involvement in patients with NSCLC (Luke et al, 1986;Lowe et al, 1998;Schimmer et al, 2006). The main problem is the fact that CT only depicts the shape and size of mediastinal lymph nodes, rather than actual tumor involvement (Kramer and Groen, 2003). During recent years PET has become a commonly used technique for the evaluation of mediastinal lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Investigation of micrometastasis by cytokeratin staining in non-small cell lung cancer patients with tumor negative mediastinoscopic lymph node biopsies

Kaya¹,

Başoğlu²,

Büyükkarabacak³

et al. 2013

jecm

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Article HistoryReceived 21 / 03 / 2013 Accepted 09 / 04 / 2013To investigate micrometastasis by using epithelial cytokeratin marker in non-small cell lung cancer (NSCLC) patients with tumor negative mediastinoscopic lymph node biopsies. Micrometastasis were investigated by immunohistochemical staining in 20 patients who were diagnosed as NSCLC with ipsilateral mediastinal lymph nodes (RN2) in CT scan and with negative histopathologic mediastinoscopic lymph node biopsy (pN0). Frozen section was studied with hematoxylin-eosin (HE), a routine histopatological method in lymph nodes taken by mediastinoscopy and in absence of metastasis; resection was applied with thoracotomy in the same session. We studied micrometastasis in lymph nodes, which are taken out by mediastinoscopy and dissected during resection, using both HE and immunohistochemical staining with cytokeratin. All patients were male and median age was 60.9 (51-74) years. In 16 cases epidermoid carcinoma, in 2 cases adenocarcinoma and in 2 cases bronchioloalveoler carcinoma were diagnosed as histopathological types.Cervical mediastinoscopy was performed in 20 patients who were diagnosed as RN2 by thorax CT radiologically, and complete resection was done in pN0 patients. Sixty lymph nodes, 40 of them taken by mediastinoscopy and 20 taken during resection, were stained immunohistochemically in 20 NSCLC patients. Only one lymph node from a single patient was positive after staining. After postoperative staging, 18 patients were at a lower stage, one patient was at the same stage, and one patient with micrometastasis was at an advanced stage. Immunohistochemical staining may be useful in detecting micrometastasis in NSCLC. Standard cervical mediastinoscopy is still gold standard in preoperative staging. Efficiency can be increased by combining mediastinoscopy, a gold standard method in staging, with immunohistochemical methods.

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Current Concepts in the Mediastinal Lymph Node Staging of Nonsmall Cell Lung Cancer

Cited by 95 publications

References 94 publications

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Automated temporal tracking and segmentation of lymphoma on serial CT examinations

Investigation of micrometastasis by cytokeratin staining in non-small cell lung cancer patients with tumor negative mediastinoscopic lymph node biopsies

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