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Eur J Cardiothorac Surg 2004;25:492-496
© 2004 Elsevier Science NL

Re-evaluation of non-palpable scalene lymph node biopsy for the staging of non-small cell lung cancer

^a Department of Surgery, Osaka Kosei-Nenkin Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka, 553-0003, Japan
^b Internal Medicine, Osaka Kosei-Nenkin Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan

Received 28 October 2003; received in revised form 19 December 2003; accepted 23 December 2003.

^* Corresponding author. Tel.: +81-6-6441-5451; fax: +81-6-6445-8900
e-mail: ok8926{at}okn.gr.jp

Objectives: The purpose of this study was to determine the most suitable candidates for scalene lymph node biopsy to detect non-palpable scalene lymph node metastasis (N₃-scalene) in non-small cell lung cancer patients. Methods: Standard cervical mediastioscopies and ipsilateral scalene lymph node biopsies were performed preoperatively by a single surgeon on 121 consecutive patients with non-small cell lung cancer scheduled to have surgical resection between January 1997 and August 2002, who had neither evidence of distant metastasis on imaging diagnosis nor palpable supraclavicular lymph nodes. Results: N₃-scalene was detected in six patients (5.0%), who all had non-squamous cell carcinoma, including one (1.0%) out of 98 patients with negative standard cervical mediastinoscopy and five (21.7%) out of the remaining 23 patients with positive mediastinal lymph node involvement. There was a significant difference in the incidence of the N₃-scalene between the two groups (P<0.01). Five patients with N₃-scalene had metastatic lesions in the multilevel mediastinal lymph node station on the same side as the cancer (multilevel N₂), and accounted for 31.3% of 16 patients with multilevel N₂ disease_. The N₃-scalene was detected in 5 (45.5%) of 11 patients with lung cancer classified as non-squamous cell carcinoma with multilevel N₂ disease. Conclusions: The results of the present study suggest that non-palpable scalene lymph node biopsy is indicated for lung cancer patients diagnosed as having non-squamous cell carcinoma with mediastinoscopic multilevel N₂ disease.

Key Words: Biopsy • Lung cancer • Diagnosis and staging • Lymph nodes • Mediastinoscopy • Non-small cell lung cancer