Thoracic CT Scanning in the Staging of Bronchogenic Carcinoma

Richey, Harvey M.; Matthews, Joseph L.; Helsel, Robert A.; Cable, Harold

doi:10.1378/chest.85.2.218

Cited by 51 publications

(7 citation statements)

References 10 publications

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“…On the other hand, if only lymph nodes with a diameter of 1.5 cm and more are considered as su spect the sensitivity falls too much (from 81 to 68%), but the specificity increases (from 78 to 87%). Like Glazer et al [27] and Richey et al [28], we are of the opinion that a diameter of 1 cm is the most approp riate criterion for a positive lymph node; the sensitivity of the computed tomogram is significantly better than when a diame ter of 1.5 cm is the criterion. Naturally, the selection of a particular node size for this purpose is arbitrary.…”

Section: Discussionsupporting

confidence: 51%

Mediastinal Staging of Bronchial Carcinoma: Can Computed Tomography Replace Mediastinoscopy?

et al. 1985

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In bronchial carcinoma the assessment of operability requires an accurate evaluation of the regional and mediastinal lymph nodes. For this, both mediastinoscopy and computed tomography are often used on a routine basis today. The present work considers the relative value of these two methods of investigation. Fifty-seven patients with bronchial carcinoma, in whom both investigations were carried out prior to surgery, were included in this prospective study. In the computed tomogram, lymph nodes with a diameter of more than 1 cm were defined as positive (i.e. suspected malignant infiltration). Sixteen of the 57 patients had histologically confirmed lymph node metastases; in 13 cases the metastases were detected by computed tomography, in 12 cases also by mediastinoscopy and in 3 cases only at thoracotomy. In 41 of the thoracotomized patients, no mediastinal metastases were found. As was to be expected, mediastinoscopy also proved negative in these cases. In 9 of these cases, however, the preoperative computed tomography findings were false-positive. For computed tomography the specificity was 78% and the sensitivity 81 %; for mediastinoscopy, on the other hand, the specificity was 100% and the sensitivity 75%. The specificity of computed tomography is too low. Also, lymph nodes which are only inflamed may be considerably enlarged and cannot be differentiated in the computed tomogram from those with malignant infiltration. Mediastinal lymph nodes which appear enlarged in the computed tomogram therefore have to be further investigated by mediastinoscopy. However, in this prospective study, mediastinoscopy provided no additional information in those cases in whom the computed tomography findings were negative (lymph node diameter ≤1 cm); it did not detect the metastases in the 3 patients with false-negative computed tomography findings. Therefore, in the case of a negative computed tomogram, thoracotomy may be performed immediately, without previous mediastinoscopy.

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Section: Discussionsupporting

confidence: 51%

Mediastinal Staging of Bronchial Carcinoma: Can Computed Tomography Replace Mediastinoscopy?

et al. 1985

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“…However, several studies demonstrated that enlarged glands on CT scanning are not necessarily metastatic [7][8][9][10][11][12][13]. It was shown that histological proof is mandatory before a patient is judged inoperable [8].…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging

Gdeedo

Schil²,

Corthouts³

et al. 1997

Eur Respir J

164

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Twenty five (25%) mediastinoscopies were positive and three were false-negative (3%). There were 29 false-positive CT scans and 12 false-negative. Overall sensitivity and specificity of CT were 63 and 57%, respectively, and of mediastinoscopy 89 and 100%, respectively. Positive and negative predictive values of CT were 41 and 77%, respectively, and of mediastinoscopy 100 and 96%, respectively. Accuracy of CT was 59% and of mediastinoscopy 97%. Accuracy of CT was lowest for left-sided and centrally located tumours, and for LN station 7.Even with current computed tomography scanners, sensitivity and specificity remain low. Although overall cost may increase, routine cervical mediastinoscopy is necessary for precise staging of non-small cell lung cancer, and subcarinal lymph nodes should be routinely sampled.

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“…The possibility of malignant normal-sized lymph nodes and cancer-free enlarged ones indicates that imaging techniques such as computed tomography (CT) cannot reliably replace histological staging [15,16,[19][20][21]. However, CT can increase the accuracy of this method in staging lymph nodes, as an adjunctive map depicting anatomic landmarks for TBNA [18,22,23].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Rigid and Flexible Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma

Bilaçeroğlu

Cagiotariotaciota²,

Günel³

et al. 1998

Respiration

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In staging bronchogenic carcinoma by transbronchial needle aspiration (TBNA), rigid histology needles are generally preferred to flexible cytology needles owing to the widespread opinion that rigid needles have higher diagnostic yield and less false-positive results. The objective of this study was to compare the efficacy and safety of the rigid and flexible TBNAs in staging bronchogenic carcinoma to establish whether a flexible cytology needle method can replace the rigid needle. A prospective study was conducted in 138 consecutive patients with extra- or endobronchial masses suggestive of bronchogenic carcinoma and amenable to surgical procedures. All 8 mm and larger paratracheal, carinal, hilar and/or main bronchial lymph nodes determined before bronchoscopy by computed tomography (CT) were sampled by successive 18-gauge rigid and 21-gauge flexible TBNAs in the same session. The anatomic landmarks were followed precisely during TBNAs, and a proper technique applied in sampling and specimen processing. Malignant lymph node involvement was specified in 97 (72%) cases of bronchogenic carcinoma by rigid, and in 89 (66%) by flexible TBNA. There were 4 (100%) benign cases (3 with tuberculosis and 1 with sarcoidosis) of 101 (73%) with positive rigid TBNAs (82 with histological and 19 with cytological specimens). TBNAs determined malignant lymph node involvement in a total of 104 (78%) patients. Of 30 TBNA-negative patients, 14 were proven to have false-negative TBNAs by mediastinoscopy/mediastinotomy/minithoracotomy, and 16 to have true-negative TBNAs by thoracotomy. Thoracotomy confirmed true positivity in 52 rigid and 49 flexible TBNAs, and false negativity in 4 rigid and 7 flexible TBNAs. Further staging was confirmed in these 7 cases. Four had proven false-negative results by both methods. The presence of small cell carcinoma (21) or N₃ disease (27) presented a contraindication to thoracotomy in 48 TBNA-positive patients. Adequate-quality and malignant lymph node specimens were more frequently obtained by both techniques at advanced tumor and node stages. However, malignant lymph node invasion was significantly more frequent in rigid and flexible TBNA specimens only in the presence of advanced tumor status and abnormal endoscopic appearance. The sensitivities of rigid and flexible TBNAs were 74 and 70%, respectively (p > 0.05), but both had a specificity of 100%. Neither false-positive results nor serious complications other than hemorrhage of 30–100 ml (rigid: 5%, flexible: 2%) were encountered with either technique. These results indicate that in bronchogenic carcinoma, hilar and mediastinal lymph nodes can be staged by 21-gauge flexible TBNA (76%) as accurately as by 18-gauge rigid TBNA (79%) if a proper technique is applied and anatomic landmarks are followed precisely (p > 0.05).

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Thoracic CT Scanning in the Staging of Bronchogenic Carcinoma

Cited by 51 publications

References 10 publications

Mediastinal Staging of Bronchial Carcinoma: Can Computed Tomography Replace Mediastinoscopy?

Mediastinal Staging of Bronchial Carcinoma: Can Computed Tomography Replace Mediastinoscopy?

Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging

Comparison of Rigid and Flexible Transbronchial Needle Aspiration in the Staging of Bronchogenic Carcinoma

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