Mediastinal Biopsy for Indeterminate Pulmonary and Mediastinal Lesions

Stemmer, Edward A.; Calvin, James W.; Chandor, Stebbins B.; Connolly, John E.

doi:10.1016/s0022-5223(19)33276-3

Cited by 28 publications

(3 citation statements)

References 3 publications

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“…Exploration of the subaortic and para-aortic nodal stations is indicated in left lung cancers. This can be done by parasternal mediastinotomy ( 13 , 14 ), extended cervical mediastinoscopy ( 15 - 17 ), or video-assisted thoracoscopic surgery (VATS) ( 18 ).…”

Section: Cervical Mediastinoscopymentioning

confidence: 99%

Cervical mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for the staging of non-small cell lung cancer

Call¹,

Rami‐Porta²

2019

Mediastinum

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The staging of mediastinal lymph nodes is essential for planning the most adequate treatment for patients with non-small cell lung cancer (NSCLC). For this reason, the current American and European guidelines recommend obtaining tissue confirmation of any mediastinal abnormality seen on chest computed tomography (CT) and positron emission tomography (PET). This can be done by endoscopic techniques, such as endobronchial ultrasonographic fine-needle aspiration (EBUS-FNA), esophageal ultrasonographic FNA (EUS-FNA), or a combination of the two (CUS). Traditionally, surgical methods have been reserved to validate the negative results of minimally invasive endoscopic techniques. However, based on the latest evidence, cervical mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy (VAMLA) have demonstrated their superiority over minimally invasive methods in terms of performance for those tumors with normal mediastinum [clinical (c) N0-1 by CT and PET]. Therefore, cervical mediastinoscopy and VAMLA should be considered in the staging algorithms of this particular subset of NSCLC, and in the other well-established indications.

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Section: Cervical Mediastinoscopymentioning

confidence: 99%

Cervical mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for the staging of non-small cell lung cancer

Call¹,

Rami‐Porta²

2019

Mediastinum

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“…Anterior mediastinotomy was described by Stemmer et al (46) and McNeill and Chamberlain (47) in 1965 and 1966, respectively. This procedure consists of a left parasternal incision at the level of the second or third intercostal space, to access the subaortic and the paraaortic nodal stations (stations 5 and 6), that cervical mediastinoscopy cannot reach.…”

Section: Parasternal Mediastinotomymentioning

confidence: 99%

Present indications of surgical exploration of the mediastinum

Call¹,

Obiols²,

Rami‐Porta³

2018

J. Thorac. Dis.

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Preoperative mediastinal staging is crucial in the management of patients with non-small cell lung cancer (NSCLC), especially to define prognosis and the most proper treatment. To obtain the highest certainty level before lung resection, the current American and European guidelines for preoperative mediastinal nodal staging for NSCLC recommend getting tissue confirmation of regional nodal spread in all cases except in patients with small (≤3 cm) peripheral carcinomas with no evidence of nodal involvement on computed tomography (CT) and positron emission tomography (PET). We have a wide variety of surgical methods for mediastinal staging that are well integrated in the current preoperative algorithms. Their main indication is the validation of negative results obtained by minimally invasive endoscopic techniques. However, recent studies have reported the superiority of mediastinoscopy over endosonography methods in terms of accuracy for those tumours classified as clinical (c) N0-1 by CT and PET or with intermediate risk of N2 disease (cN1 and central tumours). Apart from the exploration of the mediastinum, other surgical procedures [parasternal mediastinotomy, extended cervical mediastinoscopy (ECM) and video-assisted thoracoscopic surgery (VATS)] allow the completion of the staging process with the assessment of the primary tumour and metastasis, exploring the lung, pleural cavity, and pericardium when it is required. Transcervical lymphadenectomies represent the evolution of mediastinoscopy and they are already considered the most reliable method for mediastinal staging, mainly in the subgroup of patients in whom endosonography methods have a low sensitivity: tumours with normal mediastinum by CT and PET. In addition to their indication for staging, these procedures have also demonstrated to be feasible as preresectional lymphadenectomy in VATS lobectomy, improving the radicality of the number of lymph nodes and lymph node stations explored, mostly for left-sided tumours for which a complete mediastinal nodal dissection is not always possible by VATS approach.

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“…An article written in 1962 reported 33 cases treated with a procedure similar to that reported by Effler and Proudfit [12]. In 1965, Stemmer et al [13] used a parasternal approach for direct exploration of the mediastinal content without producing pneumothorax. They also described a parasternal mediastinoscopy method in 1971 [14].…”

Section: After Larrey and Romeromentioning

confidence: 99%