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Louie BE, Kapur S, Farivar AS, Youssef SJ, Gorden J, Aye RW, Vallières E. Safety and Utility of Mediastinoscopy in Non-Small Cell Lung Cancer in a Complex Mediastinum. Ann Thorac Surg 2011; 92:278-82; discussion 282-3. [DOI: 10.1016/j.athoracsur.2011.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 01/29/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Abstract
The treatment of malignant pleural mesothelioma is controversial, particularly regarding the role of surgery. Though well accepted as a diagnostic modality, surgery is also frequently used to establish stage, provide palliation, and perhaps most controversially, to offer cytoreduction with the putative goal of delaying tumor progression and prolonging survival. Pleurectomy/decortication (PD) can achieve macroscopic complete resection; however, the ability to deliver effective postoperative radiation treatment is limited because of the risk of lung toxicity. Accordingly, it has been associated with higher rates of local recurrence compared to extrapleural pneumonectomy (EPP). Extrapleural pneumonectomy generally offers a more complete cytoreduction compared to PD but at the cost of increased morbidity and mortality. Adjuvant hemithoracic radiation is feasible following EPP and in most series local recurrence rates are lower after EPP than PD. There are no convincing data, however, to show that one procedure is superior to the other in terms of survival. Furthermore, no randomized data currently exist that demonstrate a survival benefit to any form of surgical cytoreduction over systemic treatment and supportive care. If cytoreductive surgery does have a beneficial effect on long-term survival, it will most likely be realized in patients with epithelioid tumors without nodal metastases.
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Affiliation(s)
- David Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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103
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Mediastinoscopy in Patients With Lung Cancer and Negative Endobronchial Ultrasound Guided Needle Aspiration. Ann Thorac Surg 2010; 90:1753-7. [DOI: 10.1016/j.athoracsur.2010.06.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/07/2010] [Accepted: 06/11/2010] [Indexed: 11/19/2022]
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104
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Raymond DP, Watson TJ. Endoscopic evaluation of the tracheobronchial tree and mediastinal lymph nodes. Surg Clin North Am 2010; 90:1053-63. [PMID: 20955883 DOI: 10.1016/j.suc.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assessment of the airways and surrounding structures, including the mediastinum and pulmonary parenchyma, has been greatly facilitated by advancements in bronchoscopic techniques, both rigid and flexible. Recent years have seen an explosion in technologies that have revolutionized the ability to visualize, biopsy, or otherwise assess regions of potential pathology within the upper aerodigestive tract and adjacent structures. This article concisely and comprehensively reviews the endoscopic evaluation of the tracheobronchial tree and mediastinum with a focus on emerging technologies and their role in treatment of thoracic disease.
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Affiliation(s)
- Daniel P Raymond
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box Surgery, Rochester, NY 14642, USA
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105
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Kouskov OS, Almeida FA, Eapen GA, Uzbeck M, Deffebach M. Mediastinal Infection After Ultrasound-guided Needle Aspiration. J Bronchology Interv Pulmonol 2010; 17:338-41. [DOI: 10.1097/lbr.0b013e3181f30d74] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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106
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Eckardt J, Licht PB. [Endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging of lung cancer and diagnosis of intrathoracic lesions]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:403-5. [PMID: 20677632 PMCID: PMC6135955 DOI: 10.3779/j.issn.1009-3419.2010.05.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
既往研究显示,经支气管超声引导针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA)是一项微创技术,可用于肺癌患者的纵隔分期、胸腔内病变的诊断、不明原因淋巴结肿大的诊断以及非小细胞肺癌(non-small cell lung cancer, NSCLC)新辅助化疗后的纵隔再分期。 本综述旨在关注EBUS在NSCLC纵隔分期中的作用,以及EBUS在进一步评估通过常规检查仍诊断未明的胸腔内病变中的应用。总之,就NSCLC患者纵隔分期而言,由于EBUS的诊断敏感性和特异性均较高,其为纵隔镜检查的有效替代,亦可用于疑似胸腔病变的活检,且不会给患者带来任何并发症风险。
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Affiliation(s)
- Jens Eckardt
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
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107
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Groth SS, Andrade RS. Endobronchial and endoscopic ultrasound-guided fine-needle aspiration: a must for thoracic surgeons. Ann Thorac Surg 2010; 89:S2079-83. [PMID: 20493985 DOI: 10.1016/j.athoracsur.2010.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/12/2022]
Abstract
A thoracic surgeon facile in endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can accurately sample mediastinal lymph nodes (MLNs) for histologic assessment of mediastinal adenopathy and for thoracic malignancy staging. Although mediastinoscopy is the gold standard for histologic MLN assessment, EBUS-FNA and EUS-FNA have emerged as useful, less-invasive sampling techniques that offer access to a wider range of MLN stations than mediastinoscopy and can be used to biopsy suspicious lesions within (ie, peribronchial masses) and outside the mediastinum (ie, left adrenal gland masses, liver lesions, and enlarged celiac lymph nodes). The negative predictive value of EBUS-TBNA and EUS-FNA in patients with malignancy is somewhat lower than the negative predictive value of mediastinoscopy. Therefore, we recommend that nonmalignant EBUS or EUS cytologic findings should be confirmed with a surgical MLN biopsy (ie, mediastinoscopy or thoracoscopy) if the pretest probability of malignancy is high.
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Affiliation(s)
- Shawn S Groth
- Division of General Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA
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108
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Dango S, Guenter J, Passlick B. Endobronchial ultrasound-guided transbronchial needle aspiration and its role in non-small cell lung cancer: Diagnostic impact and limitations. Thorac Cancer 2010; 1:70-76. [PMID: 27755780 DOI: 10.1111/j.1759-7714.2010.00014.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A diagnostic work-up to evaluate possible mediastinal lymph node involvement in patients with non-small cell lung cancer (NSCLC) should be performed once suspected as a result of computed tomography. Cytological/histological verification is always compulsory. In recent years, diagnostic tools for mediastinal evaluation have made great technical progress with the introduction of endosonographic real-time ultrasound techniques such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Mediastinal masses as well as lymph node enlargement can be clarified by endosonographic guided biopsies and play a key role in cytological examination of mediastinal lymph nodes. The proven high sensitivity of endosonographic guided biopsies and the high negative predictive value of 20% may challenge mediastinoscopy, which has a sensitivity of 80-95%. However, with a higher positive predictive value and being the best explored method in the literature, mediastinoscopy still has a better diagnostic yield for mediastinal staging. However, according to us EBUS-TBNA should be considered for staging in patients with NSCLC primarily, but negative results must be followed by mediastinoscopic evaluation.
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Affiliation(s)
- Sebastian Dango
- Department of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jutta Guenter
- Department of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, University Medical Center Freiburg, Freiburg, Germany
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109
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Eckardt J, Licht PB. Endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging of lung cancer and diagnosis of intrathoracic lesions. Thorac Cancer 2010; 1:41-43. [DOI: 10.1111/j.1759-7714.2010.00006.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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110
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Abstract
Diagnostic bronchoscopy has undergone two major paradigm shifts in the last 40 years. First, the advent of flexible bronchoscopy gave chest physicians improved access to the tracheobronchial tree with a rapid learning curve and greater patient comfort compared with rigid bronchoscopy. The second paradigm shift has evolved over the last 5 years with the proliferation of new technologies that have significantly enhanced the diagnostic capabilities of flexible bronchoscopy compared with traditional methods. At the forefront of these new technologies is endobronchial ultrasound. In its various forms, endobronchial ultrasound has improved diagnostic yield for pulmonary masses, nodules, intrathoracic adenopathy, and disease extent, thereby reducing the need for more invasive surgical interventions. Various navigational bronchoscopy systems have become available to increase flexible bronchoscope access to small peripheral pulmonary lesions. Furthermore, various modalities of airway assessment, including optical microscopic imaging technologies, may play significant roles in the diagnosis of a variety of pulmonary diseases in the future. Finally, the combination of new diagnostic bronchoscopy technologies and novel approaches in molecular analysis and biomarker assessment hold promise for enhanced diagnosis and personalized management of many pulmonary disorders. In this review, we provide a contemporary review of diagnostic bronchoscopy developments over the past decade.
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Affiliation(s)
- Andrew R Haas
- Clinical Operations, Interventional Pulmonology and Thoracic Oncology, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Medical Center, 3600 Spruce Street, Philadelphia, PA 19104-4283, USA.
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111
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Eckardt J, Olsen KE, Licht PB. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Undiagnosed Chest Tumors. World J Surg 2010; 34:1823-7. [DOI: 10.1007/s00268-010-0536-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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112
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Andrade RS, Groth SS, Rueth NM, D'Cunha J, Pambuccian SE, Maddaus MA. Evaluation of mediastinal lymph nodes with endobronchial ultrasound: The thoracic surgeon's perspective. J Thorac Cardiovasc Surg 2010; 139:578-82; discussion 582-3. [DOI: 10.1016/j.jtcvs.2009.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 10/29/2009] [Accepted: 11/13/2009] [Indexed: 10/19/2022]
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113
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Transition From Mediastinoscopy to Endoscopic Ultrasound for Lung Cancer Staging. Ann Thorac Surg 2010; 89:885-90. [DOI: 10.1016/j.athoracsur.2009.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 11/11/2009] [Accepted: 11/12/2009] [Indexed: 11/19/2022]
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114
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Trousse D, Avaro JP. [Mediastinal tumors: introduction]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:3-16. [PMID: 20207291 DOI: 10.1016/j.pneumo.2009.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal tumors are relatively uncommon, usually incidentally discovered on a chest X-ray in asymptomatic patients. Young adults are particularly concerned. Mediastinal masses represent a group of heterogeneous histological type cell. A definite diagnosis is essential leading to an adequate prompt therapeutic strategy when either benign disease or aggressive malignant tumor is conceivable. Indeed the therapeutic management of such tumors could be strictly medical, requiring exclusive surgical approach or includes a multimodal treatment. Clinical examination and imaging are important tools in the diagnostic approach. However the specific diagnosis could be complex and requires histological confirmation by an experienced pathologist after examination of large biopsies of the tumor. Several investigations, including surgical invasive exploration, should be quickly requested in order to achieve a final diagnosis and refer patients in an adequate therapeutic scheme without delay. The aim of this article is to point out the available diagnostic tools in mediastinal masses, including surgical approach, and to identify the role of surgical resection in specific subtypes.
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Affiliation(s)
- D Trousse
- Service de Chirurgie Thoracique et Maladies de l'Oesophage, Hôpital Sainte-Marguerite, Université de la Méditérranée, 270 boulevard Sainte-Marguerite, 13274 Marseille cedex 9, France.
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115
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Riquet M, Bagan P, Fabre-Guillevin E, Scotté F, Cazes A, Le Pimpec-Barthes F. [Isolated malignant mediastinal lymphadenopathy]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:36-40. [PMID: 20207295 DOI: 10.1016/j.pneumo.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with unknown primary site. We observed 507 patients with isolated mediastinal adenopathies: benign, lymphomatous and metastatic disease represented 41.4% (210/507), 26.8% (136/507), 31.8% (161/507) of them, respectively. Management of the latter was the most challenging. Surgery was generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes in 84% of patients (135/161). However, radical surgery consisting in lymphadenectomy proved effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed long-term good results in such cases, which also was demonstrated by case reports in the literature. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Affiliation(s)
- M Riquet
- Service de Chirurgie Thoracique et Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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116
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117
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Endoscopic Ultrasound-Guided Fine Needle Aspiration for Staging of Malignant Pleural Mesothelioma. Ann Thorac Surg 2009; 88:862-8; discussion 868-9. [DOI: 10.1016/j.athoracsur.2009.05.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 05/07/2009] [Accepted: 05/08/2009] [Indexed: 11/20/2022]
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118
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Seder CW, Hanna K, Lucia V, Boura J, Kim SW, Welsh RJ, Chmielewski GW. The Safe Transition from Open to Thoracoscopic Lobectomy: A 5-Year Experience. Ann Thorac Surg 2009; 88:216-25; discussion 225-6. [PMID: 19559229 DOI: 10.1016/j.athoracsur.2009.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Revised: 03/31/2009] [Accepted: 04/02/2009] [Indexed: 11/24/2022]
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119
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Chumsri S, Tummala MK, Khna AM, Zhao XF, Rapoport AP. Persistent positron emission tomography positivity secondary to benign histiocytic proliferation after treatment of Hodgkin lymphoma. Leuk Lymphoma 2009; 48:616-8. [PMID: 17454607 DOI: 10.1080/10428190601140058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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120
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Fowkes L, Lau KK, Shah N, Black E. A Cervical Approach to Investigating Pleural Disease. Ann Thorac Surg 2009; 88:315-7. [DOI: 10.1016/j.athoracsur.2008.10.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 10/20/2022]
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121
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Kim YD, Park CB, Kim JJ, Kim CK, Moon SW. Primary Repair of an Iatrogenic Bronchial Rupture Under Video Mediastinoscopy. Ann Thorac Surg 2009; 87:e51-3. [DOI: 10.1016/j.athoracsur.2009.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/25/2009] [Accepted: 03/02/2009] [Indexed: 11/30/2022]
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122
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Groth SS, Andrade RS. Endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node staging in non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2009; 20:274-8. [PMID: 19251164 DOI: 10.1053/j.semtcvs.2008.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2008] [Indexed: 12/25/2022]
Abstract
Mediastinoscopy is the gold standard for mediastinal lymph node (MLN) staging for non-small cell lung cancer patients; however, mediastinoscopy is invasive and allows access to a limited number of American Thoracic Society MLN stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as a useful, less invasive staging technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). Although EBUS-TBNA has excellent sensitivity and diagnostic accuracy, an alternative MLN biopsy technique (i.e., mediastinoscopy or thoracoscopy) is required to confirm negative cytology findings, especially after induction therapy. Additionally, an experienced cytopathologist is critical to establishing an effective EBUS-TBNA program.
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Affiliation(s)
- Shawn S Groth
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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123
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History of thoracoscopic surgery in Japan and the world. Gen Thorac Cardiovasc Surg 2009; 57:64-70. [PMID: 19214446 DOI: 10.1007/s11748-008-0326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to review articles to learn how current thoracoscopic surgery was developed to the present status. MATERIALS AND METHODS The Internet literature search engines PubMed and Index Medicus were used to search for the published articles. Interpretation of the articles was reflected in the reviewer's personal experience, who was closely associated with the developmental history. RESULTS Altogether, 49 articles were selected and reviewed. CONCLUSIONS A variety of applications of thoracoscopy have been developed. It remains the major surgical technique in thoracic surgery.
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124
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Schipper P, Schoolfield M. Minimally invasive staging of N2 disease: endobronchial ultrasound/transesophageal endoscopic ultrasound, mediastinoscopy, and thoracoscopy. Thorac Surg Clin 2009; 18:363-79. [PMID: 19086606 DOI: 10.1016/j.thorsurg.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2005 the American College of Surgeons conducted a survey examining lung cancer practice patterns at 729 hospitals in the United States. In 11,668 surgically treated patients, 92% received a preoperative chest CT. Only 27% of these patients underwent mediastinoscopy, and lymph node material was sampled in less than half of these patients. At the time of surgical resection, additional mediastinal lymph nodes were sampled in only 58% of patients. In the remaining 42% only the lymph node material attached to the surgical specimen (N1 nodes) was sampled. Although this article discusses the finer points of the minimally invasive evaluation of the N2 lymph nodes, any procedure to evaluate these nodes is better than simply ignoring them.
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Affiliation(s)
- Paul Schipper
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Mail Code L353, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97229, USA.
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125
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Anatomical bases of left recurrent nerve lesions during mediastinoscopy. Surg Radiol Anat 2008; 31:295-9. [DOI: 10.1007/s00276-008-0451-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
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126
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Abstract
For patients with lung cancer preoperative evaluation of the mediastinal lymph nodes is important to estimate local operability and/or to consider the necessity of neoadjuvant treatment. Cervical mediastinoscopy is generally accepted as a safe and highly accurate procedure in the staging of lung cancer. Nodes accessible to CM are the levels of the superior (level 2R and 2L) and inferior (level 4R and 4L) paratracheal and subcarinal (level 7) nodal stations. Additionally extended CM and left parasternal mediastinotomy allow the exploration of the aortopulmonary window (level 5) and anterior mediastinal nodes (level 6). In locally advanced lung cancer repeat mediastinoscopy was used after induction chemotherapy or chemoradiation to reexplore the upper mediastinum in order to select patients with a higher probability to undergo complete resection. Operative mortality of both investigations is less than 0.5%; the preoperative complication rate is very low (less than 4%). Because of the higher sensitivity, specificity, and accuracy, mediastinoscopy and repeat mediastinoscopy are superior to new methods like FDG-PET, FDG-PET/CT, EBUS-FNA, and EUS-FNA.
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Affiliation(s)
- M Hinterthaner
- Klinik for Allgemeinchirurgie, Klinikum Kassel, Kassel, Germany
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127
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Radiographic Staging of Mediastinal Lymph Nodes in Non–Small Cell Lung Cancer Patients. Thorac Surg Clin 2008; 18:349-61. [DOI: 10.1016/j.thorsurg.2008.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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128
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129
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Endobronchial Ultrasound-Guided Fine-Needle Aspiration of Mediastinal Lymph Nodes: A Single Institution's Early Learning Curve. Ann Thorac Surg 2008; 86:1104-9; discussion 1109-10. [DOI: 10.1016/j.athoracsur.2008.06.042] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 06/10/2008] [Accepted: 06/11/2008] [Indexed: 12/25/2022]
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130
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Chamberlain MH, Fareed K, Nakas A, Martin-Ucar AE, Waller DA. Video-assisted cervical thoracoscopy: a novel approach for diagnosis, staging and pleurodesis of malignant pleural mesothelioma. Eur J Cardiothorac Surg 2008; 34:200-3. [DOI: 10.1016/j.ejcts.2008.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022] Open
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132
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The reliability of mediastinoscopic frozen sections in deciding on oncological surgery in bronchogenic carcinoma. Adv Ther 2008; 25:488-95. [PMID: 18523735 DOI: 10.1007/s12325-008-0060-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study was carried out to determine the accuracy of mediastinoscopic frozen section examination, performed prior to major surgery-especially where mediastinal lymph node metastasis (N2 disease) was suspected. We aimed to find out whether or not mediastinoscopic frozen section analysis was (i) a reliable tool when deciding to continue resection in lung cancer patients and (ii) reliable in diagnosing mediastinal masses. METHODS One-hundred and thirty-six patients undergoing mediastinoscopy were enrolled in this study. Resection was planned for each case, and biopsies were taken from at least two sites, including the subcarinal lymph node. Thoracotomy and resection were performed when the results of frozen section examination were negative for malignancy in patients with lung cancer. Results of frozen section examination during mediastinoscopy were compared to the results of definitive histological examination of the same specimens stained using haematoxylin-eosin. Additionally, the results of frozen section examination were compared to the results of definitive histological examination of the lymph nodes excised during resection. RESULTS We determined total sensitivity, specificity, positive predictive and negative predictive values of 94.51%, 100%, 100% and 90%, respectively. In the 105 patients with malignant diseases, these values were 93.33%, 100%, 100% and 91.84%, respectively. In the 31 patients with benign diseases, values were 96.77%, 100%, 100% and 100%, respectively. CONCLUSIONS It was confirmed that mediastinoscopy supported by frozen section examination plays an important role in establishing diagnosis and planning treatment both in benign and malignant diseases.
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Lee BE, Redwine J, Foster C, Abella E, Lown T, Lau D, Follette D. Mediastinoscopy might not be necessary in patients with non–small cell lung cancer with mediastinal lymph nodes having a maximum standardized uptake value of less than 5.3. J Thorac Cardiovasc Surg 2008; 135:615-9. [DOI: 10.1016/j.jtcvs.2007.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/27/2007] [Accepted: 09/14/2007] [Indexed: 11/29/2022]
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Ernst A, Gangadharan SP. A Good Case for a Declining Role for Mediastinoscopy Just Got Better. Am J Respir Crit Care Med 2008; 177:471-2. [DOI: 10.1164/rccm.200710-1605ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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135
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Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: The surgical management of primary lung tumors. J Thorac Cardiovasc Surg 2008; 135:247-54. [DOI: 10.1016/j.jtcvs.2007.07.060] [Citation(s) in RCA: 327] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 07/20/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022]
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136
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Vincent BD, El-Bayoumi E, Hoffman B, Doelken P, DeRosimo J, Reed C, Silvestri GA. Real-Time Endobronchial Ultrasound-Guided Transbronchial Lymph Node Aspiration. Ann Thorac Surg 2008; 85:224-30. [DOI: 10.1016/j.athoracsur.2007.07.023] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 07/06/2007] [Accepted: 07/09/2007] [Indexed: 12/25/2022]
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137
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E04-02: NCI mediastinoscopy. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000282998.11920.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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