Selective preoperative evaluation for possible N2 disease in carcinoma of the lung

Clinical predictors of N2 disease in the setting of a negative computed tomographic scan in patients with lung cancer

“…On the other hand, some researchers reported that mediastinoscopy should be considered in all patients with CT-demonstrated mediastinal nodal enlargement (clinical N2), since this factor is a strong predictor of pathologic N2 disease, to confirm the diagnosis. [6][7][8] Our results were consistent with these previous reports. Both univariate and multivariate analyses showed that clinical N2 disease is a significant predictor of pathologic N2 disease.…”

“…Some investigators reported that mediastinoscopy should be performed in all patients with surgically resectable lung cancer, [3][4][5] whereas others concluded that it should be performed only if mediastinal lymph nodes are swollen on chest computed tomography (CT). [6][7][8] This controversy results from the low sensitivity and specificity of chest CT scan in the diagnosis of N2 disease. 9,10 In an attempt to determine the indications for mediastinoscopy in lung cancer cases in which CT scan shows no mediastinal nodal enlargement, we retrospectively studied patients with surgically resected lung cancer and identified highrisk populations who had CT-negative but pathologically positive nodal involvement in the mediastinum.P reresectional diagnosis of mediastinal nodal involvement (N2) in patients with lung cancer is challenging.…”

A Clinical Prediction Rule to Estimate the Probability of Mediastinal Metastasis in Patients with Non-small Cell Lung Cancer

“…Some thoracic surgeons perform mediastinoscopy routinely, whereas others use it selectively or not at all. [5][6][7] Minimally invasive biopsy procedures continue to be underused. 8 Anecdotally, positron emission tomography (PET) with F-18 fluorodeoxyglucose tends to be used routinely where available, despite its high cost.…”

Combined Procedures for Mediastinal Staging in Non-Small Cell Lung Cancer

“…Previous studies have been performed to evaluate the accuracy of CT or Tl-201 SPECT in the evaluation of mediastinal node involvement. 3 –10,12 –14 However, most of these studies demonstrated a diagnostic value of single examination separately, and very little attention has been given to the combined examination with CT, Tl-201 SPECT and serum CEA level. Our results show that the combined examination of mediastinal nodal involvement with CT, Tl-201 SPECT and serum CEA level might increase underestimation, but decrease overestimation.…”

“…Computed tomography (CT) is the imaging modality used most commonly for preoperative non-invasive mediastinal staging. 3 –8 However, CT criteria have been reported to yield a high false-positive result rate and some investigators reported that one third of patients with enlarged mediastinal lymph nodes on CT scan did not have nodal involvement. 9,10 Therefore, the reliability of CT size criteria for node metastasis remains controversial.…”