1
|
Boada M, Sánchez-Lorente D, Libreros A, Lucena CM, Marrades R, Sánchez M, Paredes P, Serrano M, Guirao A, Guzmán R, Viñolas N, Casas F, Agustí C, Molins L. Is invasive mediastinal staging necessary in intermediate risk patients with negative PET/CT? J Thorac Dis 2020; 12:3976-3986. [PMID: 32944309 PMCID: PMC7475585 DOI: 10.21037/jtd-20-1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Tumor involvement of mediastinal lymph nodes is of high importance in non-small cell lung cancer (NSCLC). Invasive mediastinal staging is recommended in selected patients without evidence of mediastinal involvement on staging by imaging. In the present study we aimed to evaluate the effectiveness of invasive mediastinal staging in reducing pN2, its impact on survival and the risk factors for occult pN2. Methods Patients with NSCLC tumors larger than 3 cm, central tumors or cN1 cases treated in our institution between 2013 and 2018 were prospectively included in the study. Incidence of pN2 and overall survival was compared among invasively staged (IS) and non-invasively staged groups (NIS). Multivariate analysis was performed to identify risk factors of pN2. Results A total of 201 patients were included in the study, 79 (39.3%) of whom were not invasively staged (NIS group) and 122 (60.7%) were invasively staged (IS group). Incidence of cN1 and mean PET/CT uptake was different among both groups. Prevalence of pN2 was similar in both groups (7.6% in NIS vs. 12.6% in IS; P>0.05). Median survival in IS-pN2 patients was 11 months longer than in NIS-pN2 group (33.6 vs. 22.5 months; P=0.245). cN1 emerged as the only a risk factor for pN2. Conclusions Invasive staging does not reduce the incidence of pN2. However, this finding could be biased because in our series cN1 patients were more often staged and cN1 has been detected as a risk factor for pN2. In addition patient better selection after invasive staging might have an impact on overall survival. To conclude, invasive mediastinal staging in intermediate risk patients for positive mediastinal nodes is justified.
Collapse
Affiliation(s)
- Marc Boada
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - David Sánchez-Lorente
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alejandra Libreros
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carmen M Lucena
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ramón Marrades
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mario Serrano
- Pulmonology Department, Hospital de Mollet, Barcelona, Spain
| | - Angela Guirao
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rudith Guzmán
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Núria Viñolas
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Francesc Casas
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Radiotherapy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Carles Agustí
- Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Pulmonology Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laureano Molins
- Thoracic Surgery Department, Respiratory Institute, Hospital Clínic de Barcelona, Barcelona, Spain.,Thoracic Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Abstract
The pleura may be affected by primary tumors or metastatic spread of intrathoracic or extrathoracic neoplasms. Primary pleural neoplasms represent ∼10% of all pleural tumors, and malignant lesions are more common than benign lesions. The most common primary tumors include malignant pleural mesothelioma and solitary fibrous tumor. Although pleural neoplasms may initially be evaluated with computed tomography (CT) and/or fluorodeoxyglucose positron emission tomography (PET)/CT, magnetic resonance (MR) imaging is complementary to these other imaging modalities for disease staging and evaluation of patients. In this article, we discuss the etiology, clinical presentation, and imaging of pleural neoplasms, with specific attention given to the role of MR imaging.
Collapse
|
3
|
Nickell LT, Lichtenberger JP, Khorashadi L, Abbott GF, Carter BW. Multimodality Imaging for Characterization, Classification, and Staging of Malignant Pleural Mesothelioma. Radiographics 2014; 34:1692-706. [DOI: 10.1148/rg.346130089] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
4
|
Classifications of n2 non-small-cell lung cancer based on the number and rate of metastatic mediastinal lymph nodes. Clin Lung Cancer 2014; 14:651-7. [PMID: 24188630 DOI: 10.1016/j.cllc.2013.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Subdivisions of N2 non-small-cell lung cancer (NSCLC) cases based on metastatic status of mediastinal and non-mediastinal lymph nodes have been proposed. This study aimed to evaluate N2 disease classification by mediastinal lymph nodes alone. PATIENTS AND METHODS We reviewed 187 patients with NSCLC pN1-N2 who were surgically treated to evaluate the proposed classifications: number, rate, nodal zone of metastatic lymph nodes. We evaluated N2 disease classification based on mediastinal lymph nodes alone in 136 pN2 cases. RESULTS The number (1-2, 3-5, and 6 ≤) or rate (15%≥, 15%< to 40%>, and 40%≤) classification based on all metastatic lymph nodes was validated by the log-rank test and Cox proportional hazards model. After reclassification by number or rate of metastatic mediastinal lymph nodes alone, a significant difference was maintained among all groups except between the 3-5 and 6 ≤ groups. The 5-year survival rates of the 1-2, 3-5, and 6 ≤ groups were 63.4%, 32.4%, and 18.2%, respectively (1-2 vs. 3-5, P = .015; 3-5 vs. 6 ≤, P = .134). With rate classification, the 5-year survival rates of the 15%≥, 15%-40% (15%< to 40%>), and 40%≤ groups were 56.0%, 27.3%, and 5.04%, respectively (15%≥ vs. 15%-40%, P = .011; 15-40% vs. 40%≤, P = .011). The Spearman's rank correlation coefficient showed a highly significant correlation of metastatic status between mediastinal lymph nodes and all lymph nodes (both P < .001). CONCLUSION Classification by number and rate of mediastinal lymph nodes alone enabled subdivision of N2 NSCLC cases. Metastatic status of mediastinal lymph nodes reflects that of all lymph nodes and is prognostic indicators.
Collapse
|
5
|
Terán MD, Brock MV. Staging lymph node metastases from lung cancer in the mediastinum. J Thorac Dis 2014; 6:230-6. [PMID: 24624287 DOI: 10.3978/j.issn.2072-1439.2013.12.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND The presence of tumor metastases in the mediastinum is one of the most important elements in determining the optimal treatment strategy in patients with non-small cell lung cancer. This review is aimed at examining the current strategies for investigating lymph node metastases corresponding to an "N2" classification delineated by The International Staging Committee of the International Association for the Study of Lung Cancer (IASLC). METHODS Extensive review of the existing scientific literature related to the investigation of mediastinal lymph node metastases was undertaken in order to summarize and report current best practices. CONCLUSIONS N2 disease is very heterogeneous requiring multiple modalities for thorough investigation. New research is now focusing on better identifying, defining, and classifying lymph node metastases in the mediastinum. Molecular staging and sub-classifying mediastinal lymph node metastases are being actively researched in order to provide better prognostic value and to optimize treatment strategies. Non-invasive imaging, such as PET/CT and minimally invasive techniques such as endobronchial and endoscopic ultrasound guided biopsy, are now the lead investigative methods in evaluating the mediastinum for metastatic presence.
Collapse
Affiliation(s)
- Mario D Terán
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Malcolm V Brock
- Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
6
|
Sayar A, Çitak N, Büyükkale S, Metin M, Kök A, Yurt S, Çelikten A, Gürses A. Impact of extended cervical mediastinoscopy in staging of left lung carcinoma. Thorac Cancer 2013; 4:361-368. [DOI: 10.1111/1759-7714.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Adnan Sayar
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Necati Çitak
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Songül Büyükkale
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Muzaffer Metin
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Abdulaziz Kök
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Sibel Yurt
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Alper Çelikten
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| | - Atilla Gürses
- Yedikule Thoracic Surgery and Chest Disease Education and Research Hospital; Istanbul Turkey
| |
Collapse
|
7
|
Witte B, Wolf M, Hillebrand H, Kriegel E, Huertgen M. Extended cervical mediastinoscopy revisited. Eur J Cardiothorac Surg 2013; 45:114-9. [DOI: 10.1093/ejcts/ezt313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
8
|
Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
Collapse
Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | | |
Collapse
|
9
|
Jougon J, Thumerel M, Rodriguez A, Delcambre F. Video-axillaroscopy: a new mini-invasive technique for surgical exploration of the axillary region. Eur J Cardiothorac Surg 2012; 42:180-1. [PMID: 22334632 DOI: 10.1093/ejcts/ezr330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Subclavicular lymph nodes are one of the deeper lymph node groups of the lymphatic network located in the axillary region. As its location is surrounded by vessels and nerves, biopsy of subclavicular lymph nodes is not possible without eye control. We describe a new, mini-invasive technique for accessing the thoracic outlet region. Video-axillaroscopy is a reliable mini-invasive technique for targeting biopsies of lymph nodes in the axillary region. It is safer and more accurate than radio-guided techniques. Exploration of this region might benefit treatment of lymphoma and breast cancer and applications might emerge for thoracic outlet syndromes.
Collapse
Affiliation(s)
- Jacques Jougon
- Thoracic Surgery Department, Victor Segalen Bordeaux 2 University and CHU de Bordeaux, Haut Lévêque Hospital, Pessac, France.
| | | | | | | |
Collapse
|
10
|
Obiols C, Call S, Rami-Porta R, Iglesias M, Saumench R, Serra-Mitjans M, Gonzalez-Pont G, Belda J. Extended cervical mediastinoscopy: mature results of a clinical protocol for staging bronchogenic carcinoma of the left lung. Eur J Cardiothorac Surg 2011; 41:1043-6. [PMID: 22219461 DOI: 10.1093/ejcts/ezr181] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the accuracy of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma (BC) of the left lung based on our updated experience. METHODS From 1998 to 2003, 89 patients underwent routine ECM for staging of BC of the left lung. In 2004, routine positron emission tomography (PET) was included in our staging protocol and ECM was reserved for those with positive mediastinal or hilar PET images, large lymph nodes on computed tomography (CT) scan or central tumours. Following this protocol, from 2004 to 2010, we performed 132 selective ECM. ECM was considered positive when metastatic nodes or tumour involvement directly in the subaortic or para-aortic regions was confirmed pathologically. Patients with negative ECM underwent subsequent thoracotomy for tumour resection and systematic nodal dissection (SND). RESULTS Two hundred and twenty-one ECMs were performed from 1998 to 2010 (89 routine and 132 selective). In the routine ECM protocol, four cases were positive and thoracotomy was contraindicated. The remaining 85 patients were operated and five had nodal disease in subaortic (LN5) or para-aortic (LN6) stations. In the selective ECM protocol (n = 188), 132 patients underwent ECM and in 19 it was positive; the remaining 113 patients underwent thoracotomy and SND found involved LN5 or LN6 in six patients; the other 56 patients underwent direct thoracotomy and four had positive LN5 or LN6. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ECM were 0.67, 1, 1, 0.94 and 0.95, respectively. The staging values of routine/selective ECM protocols were 0.44/0.65, 1/1, 1/1, 0.94/0.94 and 0.94/0.95, respectively. CONCLUSIONS Selective ECM protocol according to CT and PET findings has high negative predictive value and accuracy. Therefore, its selective use is recommended because it saves around 30% ECM without decreasing staging values of the current protocol.
Collapse
Affiliation(s)
- Carme Obiols
- University of Barcelona, Terrassa, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
The Role of Extended Cervical Mediastinoscopy in Staging of Non-small Cell Lung Cancer of the Left Lung and a Comparison with Integrated Positron Emission Tomography and Computed Tomography: Does Integrated Positron Emission Tomography and Computed Tomography Reduce the Need for Invasive Procedures? J Thorac Oncol 2011; 6:1713-9. [DOI: 10.1097/jto.0b013e318225914e] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
|
13
|
Sánchez de Cos J, Hernández JH, López MFJ, Sánchez SP, Gratacós AR, Porta RR. SEPAR guidelines for lung cancer staging. Arch Bronconeumol 2011; 47:454-65. [PMID: 21824707 DOI: 10.1016/j.arbres.2011.06.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
Abstract
The latest tumour, lymph node and metastasis (TNM) classification by the International Association for the Study of Lung Cancer (IASLC), based on the analysis of patients from all over the world, has incorporated changes in the descriptors, especially those regarding tumor size, while proposing new group staging. A new lymph node map has also been developed with the intention of facilitating the classification of the "N" component. SEPAR recommends using this new classification. As for the procedures recommended for staging, in addition to the generalized use of computed tomography (CT), it points to the role of positron emission tomography (PET) or image fusion methods (PET/CT), which provide a better evaluation of the mediastinum and extrathoracic metastases. Endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS) for obtaining cytohistological samples have been incorporated in the staging algorithm, and it emphasizes the importance of precise re-staging after induction treatment in order to make new therapeutic decisions. Comment is made on the foreseeable incorporation in the near future of molecular staging, and systematic lymph node dissection is recommended with the intention of making a more exact surgical-pathological classification.
Collapse
|
14
|
Role of EUS for the evaluation of mediastinal adenopathy. Gastrointest Endosc 2011; 74:239-45. [PMID: 21802583 DOI: 10.1016/j.gie.2011.03.1255] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 12/11/2022]
|
15
|
Sevilla López S, Vaquero Cacho M, Menal Muñoz P, Jiménez Merchán R. [Incisions and routes of surgical access]. Arch Bronconeumol 2011; 47 Suppl 8:21-5. [PMID: 23351517 DOI: 10.1016/s0300-2896(11)70063-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The correct choice of the incision to the chest is essential for surgical success and a favorable postoperative course. The route of access to the thorax must be adapted both to the disease and to the thoracic surgeon's experience, striking a balance between aggressiveness and the safety of the technique. This article describes the characteristics of surgical incisions, including classical thoracotomy, sternotomy and its variants, thoracoscopy and minimally-invasive surgery. The distinct techniques used to explore mediastinal lymphatic areas, including video-assisted mediastinal lymphadenectomy and transcervical extended mediastinal lymphadenectomy, are also described.
Collapse
|
16
|
Wilhelm T, Klemm W, Leschber G, Harlaar JJ, Kerver ALA, Kleinrensink GJ, Nemat A. Development of a new trans-oral endoscopic approach for mediastinal surgery based on 'natural orifice surgery': preclinical studies on surgical technique, feasibility, and safety. Eur J Cardiothorac Surg 2010; 39:1001-8. [PMID: 20971020 DOI: 10.1016/j.ejcts.2010.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/08/2010] [Accepted: 09/17/2010] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In recent years, several surgical disciplines adopted endoscopic techniques. Presently, natural orifice approaches are under exploration to reduce surgical access trauma. We have developed a trans-oral endoscopic approach for endoscopic mediastinal surgery and have tested this new technique in preclinical studies for feasibility and safety. METHODS We conducted an experimental anatomical study in fresh-frozen cadavers. By a midline, sublingual incision, we placed an optical scissor through a 6.0-mm trocar in the pretracheal region and created a working space; two additional trocars were placed by bi-vestibular incisions in the oral cavity. We visualized and followed the trachea down to the main bronchi. Paratracheal and subcarinal lymph nodes were resected bilaterally; the specimen could be removed through the midline channel. In an additional animal study in pigs, we tested the feasibility and safety for this surgical approach. Anatomical dissection allowed an estimate of collateral damage. RESULTS In all cases, we could reach the target region endoscopically, and no conversion was necessary. Landmarks (the brachiocervical trunk, the azygos vein, and the pulmonary artery) were visualized easily and kept intact. A working space in the mediastinum could be established by the insufflation of air at 6-8mmHg. It was possible to harvest the specimen through the midline channel. Anatomical dissection of the cervical access route as well as of the mediastinal region showed no collateral damage. In the animal study, we encountered seroma of the surgical field due to the conditions of the animal model. The other outcomes with respect to pain and food intake were normal until the third postoperative day. No local infections occurred. Intraoperative gas exchange was normal and was not influenced by CO(2) insufflation with respect to blood gas analysis. CONCLUSION These preclinical studies showed that the mediastinum could be reached by a trans-oral endoscopic approach, based on natural orifice surgery. Complete compartment resection of the paratracheal and subcarinal lymph node stations was possible in a well-defined and clearly visible working space. This approach may enhance the extent of mediastinal resections in oncologic surgery.
Collapse
Affiliation(s)
- Thomas Wilhelm
- Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, HELIOS Klinikum Borna, Borna, Germany.
| | | | | | | | | | | | | |
Collapse
|
17
|
García-Yuste M, Matilla JM, González-Aragoneses F, Heras F. [Detection of lymph node involvement and surgical treatment of pulmonary neoplastic processes. Current state of diagnostic and therapeutic procedures]. Arch Bronconeumol 2010; 46 Suppl 1:43-9. [PMID: 20353850 DOI: 10.1016/s0300-2896(10)70011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An analysis is made of different publications associated with the surgical staging and treatment of primary and metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determine lymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of the procedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guided transbronchial needle aspiration) is evaluated in accordance to the sensitivity, specificity and positive and negative predictive value of the different methods. Another interesting challenge is to define the criteria for indicating a sublobar resection in certain tumours and patients. Different factors, age, lung function, tumour location and type of sublobar resection, are analysed. Levels of evidence and recommendations of the procedure are also considered. Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases. Its indication is based on acceptable survival rates and knowledge of the impact of various factors (interval free of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement, or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail.
Collapse
Affiliation(s)
- Mariano García-Yuste
- Servicio de Cirugía Torácica, Hospital Clínico Universitario, Valladolid, España.
| | | | | | | |
Collapse
|
18
|
Witte B, Huertgen M. Videomediastinoskopie und videoassistierte mediastinoskopische Lymphadenektomie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2009. [DOI: 10.1007/s00398-009-0706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|