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European Journal of Cardio-Thoracic Surgery, Vol 12, 706-712, Copyright © 1997 by European Association for Cardio-thoracic Surgery
P De Leyn, J Vansteenkiste, P Cuypers, G Deneffe, D Van Raemdonck, W Coosemans, J Verschakelen and T Lerut
OBJECTIVE: The results of primary surgery for non-small cell lung cancer
(NSCLC) with involved ipsilateral mediastinal or subcarinal lymph nodes (N2
disease) remains poor. However, several studies suggest that induction
chemotherapy could increase long-term survival in patients with N2 disease.
Therefore, accurate preoperative staging of the mediastinum remains of
paramount importance for the treatment policy in patients with NSCLC.
Enlarged mediastinal lymph nodes (MLN) on CT scan are positive in only half
of the patients. Small lymph nodes can contain metastatic deposits of
clinical importance. However, many surgeons believe that a normal
mediastinum at computed tomography allows them to cancel their preoperative
mediastinal exploration. It was the aim of this study to evaluate the
results of cervical mediastinoscopy in patients without enlarged MLN on CT
scan. METHODS: Between January 1990 and June 1994, 235 patients with
potentially operable NSCLC underwent a cervical mediastinoscopy despite the
absence of enlarged MLN on CT scan. MLN were considered enlarged if they
were equal to or larger than 15 mm at their maximal cross-sectional
diameter. RESULTS: Cervical mediastinoscopy was positive in 47 patients
(20%). In 21 patients, N2 disease was extranodal and in 16 patients more
than one level was involved. Mediastinoscopy was positive in 9.5% of the
cT1N0 cases, in 17.7% of the cT2N0 lesions, in 31.2 and 33.3% of cT3N0 or
cT4N0 tumors, respectively. After a negative cervical mediastinoscopy,
resectability for unforeseen N2 disease was as high as 95%. CONCLUSION: We
recommend a cervical mediastinoscopy in every patient with potentially
operable NSCLC.
ARTICLES
Role of cervical mediastinoscopy in staging of non-small cell lung cancer without enlarged mediastinal lymph nodes on CT scan
Department of Thoracic Surgery, University Hospitals Leuven, Belgium.
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