Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma

Gilart, Jorge Freixinet; Garcı́a, Pablo Gámez; Castro, Felipe Rodrı́guez de; Suárez, Pedro Rodríguez; Rodrı́guez, Norberto Santana; Ugarte, Andrés Varela de

doi:10.1016/s0003-4975(00)01825-7

Cited by 65 publications

(33 citation statements)

References 10 publications

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“…Reported sensitivity and negative predictive value (NPV) of anterior mediastinotomy in assessment of AP window LNs is 78% and 91% respectively (2). Extended cervical Med introduced by Kirschner in 1971, and popularized by Ginsburg, allows access to levels 5, 6, 2, 4 and 7 (14)(15)(16). Reported sensitivity of extended Med ranges from 71% to 81% while NPV is 91% (13).…”

Section: Review Articlementioning

confidence: 99%

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Czarnecka‐Kujawa¹,

Yasufuku²

2017

J. Thorac. Dis.

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This review provides an update on the current role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and mediastinoscopy (Med) in assessment of patients with non-small cell lung cancer (NSCLC). Invasive mediastinal lymph node (LN) staging is the major application for both of these techniques. Up until recently, Med was the gold standard for invasive mediastinal LN staging in NSCLC. However, EBUS-TBNA has shown to be equivalent, and in some studies better than Med for invasive staging of lung cancer. EBUS-TBNA offers access to N1 LNs and development of the thin convex probe EBUS (TCP-EBUS) will expand EBUS-TBNA access from the paratracheal region and central airways to more distal parabronchial regions allowing for more extensive N1 LN assessment and sampling more distal lung tumors. EBUS-TBNA is more cost-effective than Med and it is currently recommended as the test of first choice for invasive mediastinal LN staging in lung cancer. ConfirmatoryMed should be performed selectively in patients with high pretest probability of metastatic disease. Addition of esophageal ultrasound fine needle aspiration (EUS-FNA) may increase diagnostic yield of EBUS-TBNA mediastinal staging. Both Med and EBUS-TBNA can be used in primary lung cancer diagnosis, restaging of the mediastinum following neoadjuvant therapy and in diagnosis of lung cancer recurrence. In the future, a combination of EBUS-TBNA with or without EUS-FNA and Med is most likely going to provide the most optimal invasive assessment of the mediastinum in patients with lung cancer. The decision on test choice and sequence should be made on a case-by-case basis and factoring in local resources and expertise.

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Section: Review Articlementioning

confidence: 99%

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

Czarnecka‐Kujawa¹,

Yasufuku²

2017

J. Thorac. Dis.

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“…Thus, mediastinal staging is essential to determine the treatment strategy (1). Mediastinoscopy remains the gold standard for the evaluation of mediastinal lymph node involvement and exhibits a sensitivity of about 80% with a specificity of, by definition, 100% (2,3). Mediastinoscopy entails a low but existing risk (0.5%) of life-threatening complications such as hemorrhage, mediastinitis, pneumothorax, or vocal cord paresis (4,5).…”

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confidence: 99%

18F-FDG PET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense?

Hellwig

Graeter²,

Ukena

et al. 2007

Journal of Nuclear Medicine

173

111

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18 F-FDG PET is the most accurate noninvasive modality for staging mediastinal lymph nodes in lung cancer. Besides using visual image interpretation, some institutions use standardized uptake value (SUV) measurements in lymph nodes. Mostly, an SUV of 2.5 is used as the cutoff, but this choice was never deduced from respective studies. Receiver operating characteristic (ROC) analyses demonstrated that SUV thresholds of more than 4 resulted in the highest accuracy. But these high cutoffs imply high false-negative rates (FNRs). The aim of our evaluation was to determine an optimal SUV threshold and to compare its diagnostic performance with the results of visual interpretation. Methods: This retrospective study included 95 patients with suspected lung cancer who underwent mediastinoscopy/mediastinal lymphadenectomy after 18 F-FDG PET (90-150 min after 250 MBq of 18 F-FDG). Maximum SUV was measured in 371 lymph node regions biopsied afterward and visually interpreted using a 6-level score (2 2 2 through 1 1 1). Diagnostic performance was assessed by ROC analysis. FNR and false-positive rate (FPR), the sum of both error rates (FNR 1 FPR), and diagnostic accuracy were plotted against a hypothetical SUV threshold to determine the optimum SUV threshold. Results: SUVs in metastatic lymph nodes were higher (mean 6 SD, 7.1 6 4.5; range, 1.4-26.9; n 5 70) than in tumor-free lymph node stations (2.4 6 1.7; range, 0.6-14.9; n 5 301; P , 0.01). Inflammatory lymph nodes exhibited slightly increased SUVs (2.7 6 2.0; range, 0.8-14.9; n 5 146). The plot of error rates featured a minimum of the sum FNR 1 FPR for an SUV of 2.5. With increasing SUV threshold, the FPR decreased most prominently up to that value whereas a continuous rise of FNR was noticed. Highest diagnostic accuracy was achieved with an SUV of 4.5. The areas under the ROC curves demonstrated that visual interpretation tends to be more accurate than SUV quantification (visual, 0.930 6 0.022; SUV, 0.899 6 0.025; P 5 0.241). Using an SUV of 2.5 as the threshold, the resulting sensitivity, specificity, and negative predictive value were 89%, 84%, and 96%, respectively. Conclusion: For mediastinal staging, the choice of an SUV of 2.5 as the threshold is justified because FNR 1 FPR is minimized. The resulting high negative predictive value of 96% allows the omission of mediastinoscopy in patients with negative mediastinal findings on 18 F-FDG PET images. For the experienced observer, visual analysis should be relied on primarily, with calculation of the SUV used, at most, as a secondary aid. For the less experienced observer, the SUV may be of greater value.

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“…Mediastinoscopy is the gold standard for mediastinal lymphatic staging because of its remarkable sensitivity of approximately 80%, with a specificity of, by definition, 100% (11,12). Nevertheless, mediastinoscopy has the risk of life-threatening complications, such as hemorrhage, mediastinitis, pneumothorax, and vocal cord paresis (13).…”

mentioning

confidence: 99%

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

Misawa¹,

Demura²,

Ishizaki³

et al. 2008

J Nucl Med

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The purpose of this study was to compare the efficacy of short-t inversion-recovery (STIR) MRI and 18 F-FDG PET/CT for the detection of metastasis in mediastinal and hilar lymph nodes in patients with lung cancer. Methods: Ninety-three patients with known or suspected lung cancer with mediastinal and hilar lymph node swelling underwent STIR MRI and 18 F-FDG PET/CT examinations. STIR MRI scans were obtained with a 2% copper sulfate phantom placed along the back of each patient, with the lymph node-to-phantom ratio calculated for quantitative analysis. For qualitative analysis, the results of all STIR MRI scans were evaluated using a 5-point visual scoring system. To evaluate the diagnostic capabilities of STIR MRI and 18 F-FDG PET/CT, we used receiver-operating-characteristic curve analysis to determine the optimal thresholds for the lymph node-to-phantom ratio, visual score, and maximal standardized uptake value. Further, the capability of each to determine N-stage was compared in each patient using the McNemar test. Results: A total of 137 lymph nodes (82 malignant lesions, 55 benign lesions) were analyzed. When optimal threshold values were adopted, the quantitative and qualitative sensitivity, specificity, and accuracy of STIR MRI were not significantly different from those of 18 F-FDG PET/CT. However, 18 F-FDG PET/CT in combination with qualitative STIR MRI analysis had a significantly higher capability to detect nodal involvement on an individual-patient basis (96.9% specificity, 90.3% accuracy) than did 18 F-FDG PET/CT alone (65.6% specificity, 81.7% accuracy). Conclusion: We found that the diagnostic capability of STIR MRI was not significantly different from that of 18 F-FDG PET/CT. However, when those methods were combined, the diagnostic capability for N-staging was significantly improved.

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Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma

Cited by 65 publications

References 10 publications

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

18F-FDG PET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense?

The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

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Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma

Cited by 65 publications

References 10 publications

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

The role of endobronchial ultrasound versus mediastinoscopy for non-small cell lung cancer

18F-FDG PET for Mediastinal Staging of Lung Cancer: Which SUV Threshold Makes Sense?

The Effectiveness of 18F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax

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The Effectiveness of ¹⁸F-FDG PET/CT Combined with STIR MRI for Diagnosing Nodal Involvement in the Thorax