Mediastinal lymph node metastasis in patients with clinical stage I peripheral non-small-cell lung cancer

Abstract

Our aim in this study was to determine the mediastinal areas where lymphadenectomy should be done at the time of surgical resection of clinical stage I lung cancer. Between 1984 and 1994, 575 patients with clinical stage I non-small-cell lung cancer underwent lobectomy and systematic mediastinal lymphadenectomy. Mediastinal lymph nodes were pathologically positive for disease in 79 patients (14%), and positive nodes appeared normal intraoperatively in 54 patients (68%). Thirty-three percent of those patients with positive N2 (mediastinal) nodes had negative lobar (N1) nodes. In cancer of the right upper lobe, all N2 cases had the lymph node metastases in the superior mediastinal compartment. In cancer of the right middle lobe, all N2 cases but one had the metastases in subcarinal or anterior mediastinal nodes. In cancer of the right lower lobe, all N2 cases but one the metastases in subcarinal nodes. In cancer of the left upper lobe, all N2 cases had the lymph node metastases in the subaortic compartment. In cancer of the left lower lobe, all N2 cases but one had the lymph node metastases in the subcarinal area or subaortic compartment. In conclusion, systematic staging of mediastinal lymph nodes is necessary for all patients with resectable clinical stage I lung cancer. The location of the primary tumor determines the mediastinal areas where lymphadenectomy should be done to examine all lymph nodes.

Role of skip metastasis to mediastinal lymph nodes in non‐small cell lung cancer

“…Many authors have consistently shown that about onethird of resected pN2 patients have no involvement of their N1 lymph nodes [1,11,12]. In the literature, the percentage of skip metastases among pN2 patients ranges between 17% and 41% [13] (Table IV).…”

Survival Analysis in N2 (+) Patients for Whom Surgical Resection Was Performed

“…Although many researchers determined that cell type did not have any influence on survival in N2 disease, general thought is in direction of that better survival is achieved in SCC. This better survival achieved in SCC has been expressed with lower rate of metastasis to contralateral mediastinum and higher rate of intranodal invasion rather than perinodal invasion (6)(7)(8)20,21) .Naruke reported close survivals for patients with T1N2 SCC and adenocarcinoma (%30 -%35) but in T2N2 and T3N2 cases there was a difference on behalf of SCC (8). When our data were investigated according to tumour cell types; the rates of accompanying to N2 disease were determined to be; 51% (n:49) for adenocarcinoma, 38.5% (n:37) for SCC, 6.3% (n:6) for adenosquamous carcinoma and 4.2% (n:4) for others.…”

“…It has been reported in various studies that subcarinal lymph node involvement influences survival negatively (20,21). When Naruke compared survival in subcarinal lymph node involvement with those of other N2s, he obtained a result of 21.7% vs 4.3% (22).…”

Signos Radiológicos: El Signo de la Galaxia

“…Los nódulos satélites en la periferia del nódulo central pueden dar la impresión de que están fusionados y por lo tanto parecen espiculaciones, que son características de la fibrosis peritumoral en el cáncer de pulmón. Sin embargo, un cáncer pulmonar menor de 3 cm, que es el tamaño habitual reportado de la galaxia sarcoide, tiene una baja incidencia de adenopatías mediastínicas e hiliares (5) . Por lo tanto, la presencia de extensas adenopatías hiliares y mediastínicas y en especial calcificadas es más sugerente de sarcoidosis.…”