Repeat Mediastinoscopy as a Restaging Procedure

Stamatis, Georgios; Fechner, S.; Hillejan, Ludger; Hinterthaner, Marc; Krbek, Thomas

doi:10.1055/s-2005-919103

Cited by 67 publications

(45 citation statements)

References 26 publications

(22 reference statements)

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“…The 5-year survival rate for 12 patients who were N0 was 20% in contrast to 0% for the 24 patients who were N2 after remediastinoscopy [92]. One large series reported on 165 consecutive repeat CMed after induction chemotherapy [93]. Sensitivity was 74%, which is representative of most other smaller reports in the literature [91].…”

Section: Surgical Techniquessupporting

confidence: 48%

The Future in Diagnosis and Staging of Lung Cancer

Catarino

Goldstraw²

2006

Respiration

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Surgical techniques remain central to the diagnosis and staging of lung cancer. Clinical situations which invoke the role of surgery include the diagnosis of solitary pulmonary masses, staging of the mediastinum, restaging of the mediastinum and the assessment of resectability. The techniques available include cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy and different procedures for intra-operative mediastinal lymph node assessment including systematic nodal dissection, lobe-specific nodal dissection and sentinel node mapping. The staging of lung cancer is continuously evolving as technological advances combine with clinical advances to better stratify patients into treatment and prognostic categories and alter pre-operative investigation algorithms. Although most of the surgical techniques have been around for many years, it is their application in future which is likely to change. The increasing use of positron emission tomography/computed tomography fusion imaging is raising the proportion of patients being shown to have additional lesions that could contraindicate surgical treatment but which require tissue confirmation to exclude a false-positive examination. Many such lesions are amenable to the expanding techniques available to the interventional endoscopist. The relationship between the surgeon and the endoscopist must become closer to ensure that the appropriate technique is used at each point in the patient’s pathway. The future of surgical techniques will be driven by: (1) developments in screening and imaging, with a likelihood that more early stage cancers will present and may be amenable to minimally invasive surgical approaches with the possibility of a role for robotics and nanotechnology; (2) improvements in neoadjuvant therapies which will demand flawless mediastinal staging and restaging; (3) advances in molecular biology which, whilst currently requiring that surgery provide samples of tumour and lymph node tissue to fully characterize the disease, do hold the promise that ever smaller amounts of tissue will be required and that eventually the genetic fingerprint will provide a biological ultrastaging to perhaps supersede anatomical staging.

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Section: Surgical Techniquessupporting

confidence: 48%

The Future in Diagnosis and Staging of Lung Cancer

Catarino

Goldstraw²

2006

Respiration

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“…The number of removed or biopsied lymph nodes varied in the published series, but was significantly higher, than in the endoscopic needle aspiration techniques. Persisting nodal disease at repeat mediastinoscopy carries a poor survival in the majority of cases because of occult metastases; therefore, indication for surgical intervention in such an unfavourable group of patients should be evaluated very carefully [80,[87][88][89][90].…”

Section: Diagnosis For Mediastinal Nodes (N-status)mentioning

confidence: 99%

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

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“…Herth and colleagues retrospectively reviewed 124 cases of patients with proven stage IIIA, N2-positive lung cancer who underwent neoadjuvant chemotherapy followed by restaging CP EBUS-TBNA and subsequent surgical resection and lymphadenectomy (41). Although the CP EBUS-TBNA sensitivity in this setting is lower than newly diagnosed patients (76%), the yield paralleled that reported with CM in this setting (70-75%) (42)(43)(44). Similar to lung cancer staging, establishing lymph node involvement in malignant pleural mesothelioma has importance to determine therapeutic options.…”

Section: Lung Cancer Stagingmentioning

confidence: 58%

Advances in Diagnostic Bronchoscopy

Haas

Vachani

Sterman

2010

Am J Respir Crit Care Med

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Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.

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Repeat Mediastinoscopy as a Restaging Procedure

Cited by 67 publications

References 26 publications

The Future in Diagnosis and Staging of Lung Cancer

The Future in Diagnosis and Staging of Lung Cancer

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Advances in Diagnostic Bronchoscopy

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