Joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the evaluation of mediastinal lymph nodes in patients with non-small cell lung cancer

Transcervical videomediastino-thoracoscopy

Although technical advances in non-invasive and minimally invasive approaches to lung and pleural cancer diagnosis and staging have become more widely available and accurate, surgical techniques remain the gold standard in assessing the extent of loco-regional involvement. Precise surgical staging of lung or pleural tumours is pivotal in the selection of surgical candidates and for predicting survival. In some patients, both mediastinal and pleural exploration may be needed for many different reasons. Transcervical videomediastino-thoracoscopy (VMT) combines simultaneously the exploration of both the mediastinum and the pleural cavities through a single cervical incision, allowing for biopsies or sampling of the mediastinal lymph nodes, lymphadenectomy and pleuropulmonary assessment (mainly pleural effusions, tumour involvement of the visceral and parietal pleura and pulmonary nodules). Thoracic surgeons should be aware of this combined surgical approach and completely familiar with classical indications and technical details of the transcervical approach to the mediastinum and thoracoscopic exploration of the pleural cavities.

[Diagnostic value of transbronchial needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration for hilar and mediastinal lymph nodes in lung cancer patients]

背景与目的

经支气管针吸活检（transbronchial needle aspiration, TBNA）和经支气管超声引导针吸活检（endobronchial ultrasound-guided TBNA, EBUS-TBNA）是用于诊断纵隔淋巴结病变的最新检查方法。本研究旨在评价TBNA和EBUS-TBNA对肺癌伴肺门纵隔淋巴结转移的诊断价值及安全性。

方法

对CT检查疑似肺癌但管腔内无明显新生物且肺门纵隔淋巴结肿大的250例患者行TBNA后行活检或刷检，15例疑似肺癌患者行EBUS-TBNA。

结果

180例患者TBNA、刷检和活检确诊为肺癌，阳性率分别为82.86%、51.24%和45.45%。15例EBUS-TBNA的阳性率为91.67%。

结论

TBNA和EBUS-TBNA检查安全性好，准确率高，对肺癌伴肺门纵隔淋巴结转移的患者有较高的诊断价值。