1
|
Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Aalbers AGJ, Beets GL, Boerma EJG, Borstlap J, van Breest Smallenburg V, Burger JWA, Crolla RMPH, Daniëls-Gooszen AW, Davids PHP, Dunker MS, Fabry HFJ, Furnée EJB, van Gils RAH, de Haas RJ, Hoogendoorn S, van Koeverden S, de Korte FI, Oosterling SJ, Peeters KCMJ, Posma LAE, Pultrum BB, Rothbarth J, Rutten HJT, Schasfoort RA, Schreurs WH, Simons PCG, Smits AB, Talsma AK, The GYM, van Tilborg F, Tuynman JB, Vanhooymissen IJ, van de Ven AWH, Verdaasdonk EGG, Vermaas M, Vliegen RFA, Vogelaar FJ, de Vries M, Vroemen JC, van Vugt ST, Westerterp M, van Westreenen HL, de Wilt JHW, van der Zaag ES, Zimmerman DDE, Marijnen CAM, Tanis PJ, Kusters M. ASO Visual Abstract: Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting. Ann Surg Oncol 2023; 30:5486-5488. [PMID: 37394674 DOI: 10.1245/s10434-023-13666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Radiology, Department of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Arend G J Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Jaap Borstlap
- Department of Radiology, Treant Zorggroep, Hoogeveen, the Netherlands
| | | | | | | | | | - Paul H P Davids
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Michalda S Dunker
- Department of Surgery, Northwest Clinics, NWZ Alkmaar, Alkmaar, the Netherlands
| | - Hans F J Fabry
- Department of Surgery, Bravis Hospital, Roosendaal, the Netherlands
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Fleur I de Korte
- Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisanne A E Posma
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Bareld B Pultrum
- Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Harm J T Rutten
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Petra C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Aaldert K Talsma
- Department of Surgery, Deventer Hospital, Deventer, the Netherlands
| | - G Y Mireille The
- Department of Radiology, Bravis Hospital, Roosendaal, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Inge J Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Joy C Vroemen
- Department of Radiology, Flevoziekenhuis, Almere, the Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.
| |
Collapse
|
2
|
Sluckin TC, Hazen SMJA, Horsthuis K, Beets-Tan RGH, Aalbers AGJ, Beets GL, Boerma EJG, Borstlap J, van Breest Smallenburg V, Burger JWA, Crolla RMPH, Daniëls-Gooszen AW, Davids PHP, Dunker MS, Fabry HFJ, Furnée EJB, van Gils RAH, de Haas RJ, Hoogendoorn S, van Koeverden S, de Korte FI, Oosterling SJ, Peeters KCMJ, Posma LAE, Pultrum BB, Rothbarth J, Rutten HJT, Schasfoort RA, Schreurs WH, Simons PCG, Smits AB, Talsma AK, The GYM, van Tilborg F, Tuynman JB, Vanhooymissen IJS, van de Ven AWH, Verdaasdonk EGG, Vermaas M, Vliegen RFA, Vogelaar FJ, de Vries M, Vroemen JC, van Vugt ST, Westerterp M, van Westreenen HL, de Wilt JHW, van der Zaag ES, Zimmerman DDE, Marijnen CAM, Tanis PJ, Kusters M. Evaluation of National Surgical Practice for Lateral Lymph Nodes in Rectal Cancer in an Untrained Setting. Ann Surg Oncol 2023; 30:5472-5485. [PMID: 37340200 PMCID: PMC10409808 DOI: 10.1245/s10434-023-13460-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/12/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Involved lateral lymph nodes (LLNs) have been associated with increased local recurrence (LR) and ipsi-lateral LR (LLR) rates. However, consensus regarding the indication and type of surgical treatment for suspicious LLNs is lacking. This study evaluated the surgical treatment of LLNs in an untrained setting at a national level. METHODS Patients who underwent additional LLN surgery were selected from a national cross-sectional cohort study regarding patients undergoing rectal cancer surgery in 69 Dutch hospitals in 2016. LLN surgery consisted of either 'node-picking' (the removal of an individual LLN) or 'partial regional node dissection' (PRND; an incomplete resection of the LLN area). For all patients with primarily enlarged (≥7 mm) LLNs, those undergoing rectal surgery with an additional LLN procedure were compared to those undergoing only rectal resection. RESULTS Out of 3057 patients, 64 underwent additional LLN surgery, with 4-year LR and LLR rates of 26% and 15%, respectively. Forty-eight patients (75%) had enlarged LLNs, with corresponding recurrence rates of 26% and 19%, respectively. Node-picking (n = 40) resulted in a 20% 4-year LLR, and a 14% LLR after PRND (n = 8; p = 0.677). Multivariable analysis of 158 patients with enlarged LLNs undergoing additional LLN surgery (n = 48) or rectal resection alone (n = 110) showed no significant association of LLN surgery with 4-year LR or LLR, but suggested higher recurrence risks after LLN surgery (LR: hazard ratio [HR] 1.5, 95% confidence interval [CI] 0.7-3.2, p = 0.264; LLR: HR 1.9, 95% CI 0.2-2.5, p = 0.874). CONCLUSION Evaluation of Dutch practice in 2016 revealed that approximately one-third of patients with primarily enlarged LLNs underwent surgical treatment, mostly consisting of node-picking. Recurrence rates were not significantly affected by LLN surgery, but did suggest worse outcomes. Outcomes of LLN surgery after adequate training requires further research.
Collapse
Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Karin Horsthuis
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Arend G J Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Geerard L Beets
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - Jaap Borstlap
- Department of Radiology, Treant Zorggroep, Hoogeveen, the Netherlands
| | | | | | | | | | - Paul H P Davids
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Michalda S Dunker
- Department of Surgery, Northwest Clinics, NWZ Alkmaar, Alkmaar, the Netherlands
| | - Hans F J Fabry
- Department of Surgery, Bravis Hospital, Roosendaal, the Netherlands
| | - Edgar J B Furnée
- Division of Abdominal Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Robbert J de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Fleur I de Korte
- Department of Radiology, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisanne A E Posma
- Department of Surgery, Slingeland Hospital, Doetinchem, the Netherlands
| | - Bareld B Pultrum
- Department of Surgery, Martini Hospital, Groningen, the Netherlands
| | - Joost Rothbarth
- Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
| | - Harm J T Rutten
- GROW School for Oncology and Reproduction, University of Maastricht, Maastricht, the Netherlands
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Petra C G Simons
- Department of Radiology, VieCuri Medical Centre, Venlo, the Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Aaldert K Talsma
- Department of Surgery, Deventer Hospital, Deventer, the Netherlands
| | - G Y Mireille The
- Department of Radiology, Bravis Hospital, Roosendaal, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Inge J S Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Roy F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - Joy C Vroemen
- Department of Radiology, Flevoziekenhuis, Almere, the Netherlands
| | | | - Marinke Westerterp
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter J Tanis
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.
| |
Collapse
|
3
|
Voogt EL, Nordkamp S, van Zoggel DM, Daniëls-Gooszen AW, Nieuwenhuijzen GA, Bloemen JG, Creemers GJ, Cnossen JS, van Lijnschoten G, Burger JW, Rutten HJ, Nederend J. MRI tumour regression grade in locally recurrent rectal cancer. BJS Open 2022; 6:zrac033. [PMID: 35552373 PMCID: PMC9097816 DOI: 10.1093/bjsopen/zrac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate the agreement between magnetic resonance tumour regression grade (mrTRG) and pathological regression grade (pTRG) in patients with locally recurrent rectal cancer (LRRC). Also, the reproducibility of mrTRG was investigated. METHODS All patients with LRRC who underwent a resection between 2010 and 2018 after treatment with induction chemotherapy and neoadjuvant chemo(re)irradiation in whom a restaging MRI was available were retrospectively selected. All MRI scans were reassessed by two independent radiologists using the mrTRG, and the pTRG was reassessed by an independent pathologist. The interobserver agreement between the radiologists as well as between the radiologists and the pathologist was assessed with the weighted kappa test. A subanalysis was performed to evaluate the influence of the interval between imaging and surgery. RESULTS Out of 313 patients with LRRC treated during the study interval, 124 patients were selected. Interobserver agreement between the radiologists was fair (k = 0.28) using a two-tier grading system (mrTRG 1-2 versus mrTRG 3-5). For the lead radiologist, agreement with pTRG was moderate (k = 0.52; 95 per cent c.i. 0.36 to 0.68) when comparing good (mrTRG 1-2 and Mandard 1-2) and intermediate/poor responders (mrTRG 3-5 and Mandard 3-5), and the agreement was fair between the other abdominal radiologist and pTRG (k = 0.39; 95 per cent c.i. 0.22 to 0.56). A shorter interval (less than 7 weeks) between MRI and surgery resulted in an improved agreement (k = 0.69), compared with an interval more than 7 weeks (k = 0.340). For the lead radiologist, the positive predictive value for predicting good responders was 95 per cent (95 per cent c.i. 71 per cent to 99 per cent), whereas this was 56 per cent (95 per cent c.i. 44 per cent to 66 per cent) for the other radiologist. CONCLUSION This study showed that, in LRRC, the reproducibility of mrTRG among radiologists is limited and the agreement of mrTRG with pTRG is low. However, a shorter interval between MRI and surgery seems to improve this agreement and, if assessed by a dedicated radiologist, mrTRG could predict good responders.
Collapse
Affiliation(s)
- Eva L.K. Voogt
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | - Stefi Nordkamp
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
| | | | | | | | | | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jeltsje S. Cnossen
- Department of Radiation Oncology, Catherina Hospital, Eindhoven, the Netherlands
| | - Gesina van Lijnschoten
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | | | - Harm J.T. Rutten
- Department of Surgery, Catherina Hospital, Eindhoven, the Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| |
Collapse
|
4
|
Bramer S, van Beek MWPM, Nieuwenhuijzen GAP, Daniëls-Gooszen AW, van den Borne BEEM, de Hingh IHJT. [Acute abdominal pain and fever in a young woman as the first symptoms of lymphangioleiomyomatosis]. Ned Tijdschr Geneeskd 2008; 152:33-37. [PMID: 18240760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A previously healthy 28-year-old woman presented to the emergency clinic with acute severe abdominal pain and high fever. A diagnostic laparoscopy was performed, during which a large retroperitoneal tumour was found. A CT-scan of the abdomen and thorax confirmed the presence of a retroperitoneal mass but also revealed multiple renal angiomyolipomas and extensive cystic lesions in all lung fields. Based on these findings, the diagnosis lymphangioleiomyomatosis (LAM) was suspected, and later confirmed by histological examination of a biopsy specimen. The acute abdomen and fever appeared to have been caused by a Streptococcus agalactiae infection of the retroperitoneal lymphangiomyoma, which was treated with intravenous antibiotics. LAM is a very rare disease affecting mostly women of childbearing age and presenting almost exclusively with pulmonary symptoms. This is the first description of LAM presenting with an acute surgical abdomen and fever due to infection of a lymphangiomyoma.
Collapse
Affiliation(s)
- S Bramer
- Afd. Algemene Heelkunde, Catharina-ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven
| | | | | | | | | | | |
Collapse
|
5
|
Goosens M, Smulders SA, Smeenk FW, Daniëls-Gooszen AW, Donkers-van Rossum AB, Edelbroek MA, Huysmans DA, Michels AJ, van Straten BAHM, Postmus PE. Influence of introduction of positron emission tomography on adherence to mediastinal staging protocols and performance of mediastinoscopy. J Oncol Pract 2007; 3:242-7. [PMID: 20859419 DOI: 10.1200/jop.0752002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In this study, we investigated the impact of implementation of [(18)F] fluorodeoxyglucose positron emission tomography (FDG-PET) in daily practice on adherence to mediastinal staging protocols and performance of mediastinoscopy in non-small-cell lung cancer (NSCLC) patients who are possible candidates for surgical resection. Institutional review board approval was obtained. PATIENTS AND METHODS From a nonuniversity teaching hospital and three surrounding community hospitals in Eindhoven, the Netherlands, we studied data from 143 patients with NSCLC who underwent mediastinoscopy and/or thoracotomy in three consecutive periods (1, 0 to 9 months; 2, 10 to 18 months; and 3, 19 to 31 months) after introduction of PET. Mediastinoscopy was indicated in case of enlarged and/or PET-positive nodes. Adherence to these surgical mediastinal staging guidelines and the performance of PET and mediastinoscopy were investigated and compared between the three periods and with our previous study before introduction of PET. RESULTS AND CONCLUSION Guidelines for indicating mediastinoscopy were adequately followed in significantly more instances after introduction of PET (80%), compared with the period before PET (66%). Optimal yield (lymph node stations 4, right and left, and 7) of mediastinoscopy (in 27% of patients) was not significantly different from the period before PET (39% of patients). Compared with the historical data, the percentage of positive mediastinoscopies increased from 15.5 to 17.6 (not significant). We found no significant differences between the three consecutive periods with regard to adequacy of indicating and performance of mediastinoscopy. After introduction of PET, adherence to staging guidelines with respect to mediastinoscopy improved. Although fewer mediastinoscopies had an optimal yield, more proved to be positive for metastases. Nevertheless, when a mediastinoscopy is indicated, surgeons must be encouraged to reach an optimal yield because PET positive nodes might be false negative. This occurred in 5% to 6% of all patients.
Collapse
Affiliation(s)
- Martijn Goosens
- Departments of Pulmonary Diseases of Catharina Hospital Eindhoven; St Anna Hospital Geldrop; VU University Medical Center Amsterdam; Department of Radiology; Department of Nuclear Medicine, Catharina Hospital Eindhoven; Department of Thoracic Surgery of Catharina Hospital Eindhoven, the Netherlands
| | | | | | | | | | | | | | | | | | | |
Collapse
|