Impact of extended cervical mediastinoscopy in staging of left lung carcinoma

Abstract

Background: Extended cervical mediastinoscopy (ECM) is a method for staging lung carcinoma. We aimed to demonstrate the impact of ECM in the staging of lung carcinoma. Methods: Between 1998 and 2011, 159 patients with left lung carcinoma who underwent ECM simultaneously with standard cervical mediastinoscopy (SCM), were retrospectively analyzed. Until 2006, ECM had been performed routinely (n = 90, routine ECM), however, after 2006 ECM was performed only in patients selected based on computed tomography and positron emission tomography scans (n = 69, selective ECM). Results: Mediastinal lymph node metastasis was present in 36 patients by mediastinoscopy. Aortopulmonary window (APW) lymph node metastasis was present in 26 patients (10 in the routine group, 16 in the selective group), whereas the 10 patients who had mediastinal lymph node metastasis that could only be accessed by SCM, but had no APW lymph node metastasis, were excluded. The remaining 123 patients (72 in the routine group, 51 in the selective group) were identified as cN0/N1 by SCM/ECM, and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 64, 43, and 16 of these patients, respectively. According to the lymphadenectomy, APW lymph node metastasis was determined in 11 patients (seven in the routine group, four in the selective group). Sensitivity, negative predictive value (NPV), and accuracy of ECM were calculated as 0.70, 0.90, and 0.92, respectively. Staging values of routine/selective ECM protocols were 0.58/0.80, 0.89/0.91 and 0.91/0.94, respectively. The complication rate was 5% (n = 8). Conclusions: ECM has an adequate NPV and accuracy in determining metastasis to the APW lymph nodes in patients with left lung carcinoma.

Does Video-Assisted Mediastinoscopy Offer Lower False-Negative Rates for Subcarinal Lymph Nodes Compared with Standard Cervical Mediastinoscopy?

“…In addition, recent studies showed that patients selected by CT and PET to undergo mediastinoscopy have better sensitivity values than patients routinely sent for mediastinoscopy. [16][17][18] In our study, the highest false-negative rate was found on station 7, similar to that reported in a published series. [3][4][5][6]9 However, this rate was found to be lower considering the VAM group only in the present study (2.9% versus 3.8%).…”

Comparison of three‐dimensional and two‐dimensional visualization in video‐assisted thoracoscopic lobectomy

“…Mediastinal staging is important for determining the treatment method for NSCLC patients. Sayar et al reported that extended cervical mediastinoscopy has an adequate negative predictive value and accuracy in determining metastasis to the aortopulmonary window lymph node . In our study, eight cases were treated with VATS lobectomy followed by mediastinoscopy, five cases in the 3D group and three in the 2D.…”

The Prognostic Significance of Metastasis to Lymph Nodes in Aortopulmonary Zone (Stations 5 and 6) in Completely Resected Left Upper Lobe Tumors

“…Preoperative mediastinal exploration was supplemented by extended cervical mediastinoscopy in patients whose tumor lay in the LUL or left main bronchus and in those with enlarged (larger than 1 cm) aortopulmonary lymph nodes. 10,11…”