Chest
The Prognostic Significance of Preoperative Assessment of Mediastinal Lymph Nodes in Patients with Lung Cancer
Section snippets
Patient Selection
One hundred patients (89 men and 11 women), aged 39 to 76 years (mean age, 57.7 years) with known or presumptive bronchogenic carcinoma were entered into this prospective study. The pathologic diagnosis of bronchogenic carcinoma was ultimately confirmed in all cases. Diagnostic fiberoptic bronchoscopic study, two-plane roentgenograms of the chest, radioisotope scans of bone and brain, and CT of the upper abdomen, from the diaphragmatic dome to the adrenal glands, were performed in all cases.
RESULTS
Sensitivity, specificity, and accuracy of the applied diagnostic techniques of mediastinal exploration are listed in Table 1. No side- or lobe-related significant differences were observed.
CT scan proved more sensitive than either tomography or TBNA and as sensitive as mediastinoscopy in detecting mediastinal node metastases. Tomography failed in 13 patients in whom the tumor-containing nodes did not deform the normal mediastinal contours or were masked by contiguous pulmonary lesions. TBNA
DISCUSSION
There is increasing evidence in the literature that a number of variables may influence the resectability rate of lung cancer other than mediastinal node involvement.6 Further, mediastinal node involvement may not be considered an absolute sign of unresectability, even though the value of such resection remains uncertain. Consequently, the need for an extensive mediastinal investigation before thoracotomy is not accepted by all surgeons, as shown by the results of a questionnaire published by
REFERENCES (28)
Evaluation of tomography and mediastinoscopy for the detection of mediastinal lymph node metastases
Ann Thorac Surg.
(1984)- et al.
The selection of patients with bronchogenic carcinoma for mediastinoscopy
J Thorac Cardiovasc Surg.
(1976) Use of mediastinoscopy in selection of patients for lung cancer operations
Ann Thorac Surg.
(1980)- et al.
Evaluation of tomography and mediastinoscopy for the detection of mediastinal lymph node metastases
Ann Thorac Surg.
(1984) - et al.
Repeat mediastinoscopy
Ann Thorac Surg.
(1984) - et al.
Lymph node mapping and curability at various levels of metastasis in resected lung cancer
J Thorac Cardiovasc Surg.
(1978) - et al.
Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung
J Thorac Cardiovasc Surg.
(1982) - et al.
The role of transcarinal needle aspiration in the staging of bronchogenic carcinoma
Chest
(1984) Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum
Chest
(1959)Predictive value of laboratory tests
Am J Cardiol
(1975)