The Role of Mediastinoscopy in the Treatment of Lung Carcinoma

Inberg, M. V.; Klossner, J; Linna, M. I.; Puhakka, H; Tala, E; Viikari, S; Vänttinen, E

doi:10.3109/14017437209134813

Cited by 11 publications

(9 citation statements)

References 8 publications

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“…In the present series 26 patients (45%) had metastatic spread of tumor into the me diastinum, which corresponds with the level detected in earlier studies [7,8]. This allows comparison with the sensitivity and specific ity rates found in earlier series.…”

Section: Discussionsupporting

confidence: 67%

“…Since the late 1960s our policy has been to perform cervical mediastinoscopy preoperatively on all patients and thus minimize explorative thoracotomies [7], although per haps at the expense of some delay. Lately, many attempts have been made to evaluate invasive methods in favor of noninvasive staging [1,3,9], but there is still a need for a standard clinical schedule.…”

Section: Discussionmentioning

confidence: 99%

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Mediastinoscopy: Not Needed Preoperatively in CT-Negative Lung Carcinoma?

Liippo

Puhakka²,

Katevuo

et al. 1989

ORL

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The objective was to investigate the necessity of mediastinoscopy in preoperative staging of lung carcinoma in 57 operable patients. Noninvasive radiology was compared to mediastinoscopy and thoracotomy. Computed tomography (CT-scan) and mediastinoscopy were in agreement in 40 cases (70%). CT-scan was negative in 26 patients, of which 4 were false negatives. Mediastinoscopy is therefore of no benefit preoperatively for 85% (22 out of 26) of patients. Consequently, we have changed our staging policy and only patients with positive CT-scan are now subjected to mediastinoscopy.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Mediastinoscopy: Not Needed Preoperatively in CT-Negative Lung Carcinoma?

Liippo

Puhakka²,

Katevuo

et al. 1989

ORL

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“…The adoption of routine, pre-operative cervical MS undoubtedly contributed to the high resectability rates reported in subsequent surgical series [29,35,36], al though this has never been subjected to prospective, ran domised studies [5,10]. The mediastinoscopical sensitivi ty of 84% in diagnosing lymph node metastases in the superior mediastinum, found in the present study, corre sponds to results extracted from other series, reporting sensitivities from 75 to 87% [37], In a collective review, Maassen [33] reported a false-negative mediastinoscopi cal rate of 9.4%, which is also in accordance with the falsenegative rate of 11 % calculated in our series.…”

Section: Discussionmentioning

confidence: 99%

“…The widespread application throughout the years established the low morbidity as well as the high diagnostic yield of the technique [28,[30][31][32][33], The reported frequency of pos itive findings in NSCLC varies from 25 to 73% depending upon the criteria used for selecting patients for cervical MS [6,9,[30][31][32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Staging of Non-Small-Cell Lung Cancer: Computed Tomography and Cervical Mediastinoscopy

Aaby¹,

Kristensen²,

Nielsen

1995

ORL

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The exact indications for computed tomography (CT) of the thorax and mediastinoscopy (MS) in lung cancer still remain incompletely defined. The present study was designed to establish a standard approach to cervical MS for otolaryngologists, who in Denmark are traditionally involved in the staging of non-small-cell lung cancer (NSCLC). Sixty-four potentially operable patients with NSCLC underwent thoracic CT prior to bronchoscopy and cervical MS. Cervical MS alone established the histological diagnosis in 20% of the patients. In diagnosing lymph node metastases in the superior mediastinum, a criterion of 10 mm for abnormal enlargement resulted in an overall sensitivity and specificity of mediastinal CT of 81 and 84%, respectively, and the overall false-negative and false-positive rates appeared to be 10 and 29%, respectively. It could be demonstrated that mediastinal lymph nodes in patients with mediastinal metastases were significantly larger than mediastinal lymph nodes in patients without metastases. No clinicopathological characteristics could be identified to influence the accuracy of CT, except for the finding that the rate of false-negative mediastinal CT was significantly higher in patients with right-sided than in patients with left-sided lesions. It is concluded that because of the relatively low sensitivity and specificity of mediastinal CT, cervical MS remains essential in the evaluation of patients with presumed or verified NSCLC and that cervical MS, in experienced hands, is a safe and accurate procedure. For Danish otolaryngologists, the strategy of routine cervical MS, performed under general anaesthesia in the same stage as bronchoscopy, is advocated as a standard approach to mediastinal assessment for the staging of NSCLC. However, thoraco-abdominal CT is advocated for all patients with NSCLC, in whom operation is contemplated, as a supplementary investigation after other routine diagnostic and staging procedures, including cervical MS, have been carried out.

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“…One of the most important factors is the existence of metastases in the mediastinal lymph nodes. Based on the 5-year survival rate, a number of authors consider the involvement of the mediastinum, even when the resection is technically possible, to be a contraindication for surgical treatment [1][2][3][4][5][6][7][8][9]. Therefore, the evaluation of regional lymph nodes is an important part of the preoperative preparation of patients.…”

Section: Introductionmentioning

confidence: 99%