Mediastinal nodes in bronchogenic carcinoma: comparison between CT and mediastinoscopy.

Abstract

Computed tomography (CT) and mediastinoscopy were compared in 151 patients with bronchogenic carcinoma. In all patients in whom findings at mediastinoscopy were negative, all accessible nodes were either removed or sampled at thoracotomy. Several size criteria for identifying nodes as enlarged on CT scans were compared. The long axis greater than or equal to 15 mm and short axis greater than 10 mm had very low sensitivity (61%), and the long axis greater than 5 mm had a low specificity (23%). CT (long axis greater than 10 mm) allowed sensitivity equal to that of mediastinoscopy (79%) in the detection of mediastinal metastases, but the specificity with CT was lower (65% vs. 100%). In seven of 44 patients with nodes greater than 10 mm on CT scans and with positive findings at mediastinoscopy, tumor was present not in the enlarged nodes but rather in normal-sized nodes in a different nodal station. The sensitivity of CT for actual nodal stations involved with tumor was only 66%. Eighty-three percent of patients with false-negative findings at mediastinoscopy but only 33% of patients with false-negative findings at CT had surgically resectable stage IIIa disease.

Diagnostic imaging of lung cancer

“…In 1984, LIBSHITZ and MCKENNA [105] demonstrated CT sensitivity and specificity of 67% and 66% respectively using a nodal size of 1 cm to distinguish between benign nodes and those seeded with metastases. In 1988 STAPLES et al [106] demonstrated 79% sensitivity and 65% specificity for CT using a 1-cm long axis nodal cut-off measurement. A meta-analysis in 1990 of 42 CT studies assessing mediastinal lymph node metastases from NSCLC described an overall sensitivity of 0.79, a specificity of 0.78 and an accuracy of 0.79 [107].…”

“…However, in 1992 MCLOUD et al [108] using a nodal short axis measurement of 1 cm in 143 patients, returned to less inspiring figures of 64% sensitivity and 62% specificity, respectively. These studies [105,106,108] all examined patients with presumed operable lung cancer in whom complete nodal sampling was performed either at mediastinoscopy or thoracotomy. Both LIBSHITZ and MCKENNA [105] and MCLOUD et al [108] observed an increase in false-positive nodes in patients with obstructive pneumonia.…”

Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease

“…Imaging with CT and PET is neither sensitive nor specific enough to detect nodal metastasis. Several studies have compared CT to mediastinoscopy in the accurate staging of bronchogenic carcinoma [5] [6] [7]. A mediastinum that appears normal upon CT may harbor metastatic disease in 13% of cases.…”

Comparación de la Tomografía Axial Computarizada con el estudio anatomopatológico en el estadiaje ganglionar del cáncer de pulmón

“…Existen múltiples estudios 10,[19][20][21][22] que han intentado determinar la sensibilidad y especificidad de la TAC para el estadiaje ganglionar del cáncer de pulmón, obteniendo resultados no siempre congruentes. Una de las razones por la que existen estas diferencias es la decisión del tamaño que debe tener una adenopatía para considerarla sospechosa de malignidad.…”