The transcervical extended mediastinal lymphadenectomy versus cervical mediastinoscopy in non-small cell lung cancer staging

Kużdżał, Jarosław; Zieliński, Marcin; Papla, B; Urbanik, Andrzej; Wojciechowski, Wadim; Narski, Maciej; Szlubowski, Artur; Hauer, Łukasz

doi:10.1016/j.ejcts.2006.10.026

Cited by 58 publications

(19 citation statements)

References 10 publications

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“…For this aim, transbronchial needle aspiration (TBNA) has been sometimes attempted, but the procedure is not easy and the diagnostic yield is not sufficient [28,29]. Recent surgical and mediastinoscopic techniques for N-staging, such as transcervical extended mediastinal lymphadenectomy (TEMLA) and video-assisted mediastinoscopic lymphadenectomy (VAMLA), have become more accurate [30,31], but these procedures are still invasive, costly and require general anesthesia, as well as a long time and substantial manpower.…”

Section: Discussionmentioning

confidence: 99%

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Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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Background: Mediastinal lymph node staging (N-staging) is essential to optimize the treatment in non-small cell lung cancer (NSCLC). Transesophageal endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) has recently been introduced as a complementary method. However, in most reports, EUS-FNA has been performed in patients who have demonstrated enlarged lymph nodes (LNs) on CT findings. The yield of EUS/EUS-FNA in patients without enlarged mediastinal LNs by CT has so far only been evaluated in a few reports. Aims: Our aim was to compare the diagnostic accuracy of CT and EUS with or without EUS-FNA (EUS/EUS-FNA) prospectively, for N-stage in all patients with potentially resectable NSCLC, including patients with and without mediastinal LN enlargement based on CT findings. Methods: Eighty consecutive patients with potentially resectable NSCLC based on CT findings were enrolled in this prospective comparative study, and underwent EUS/EUS-FNA. Results: Pathological N-stage was established in 78 patients, while in another 2 cases, malignant pleural effusion was proven by EUS-FNA, and we avoided further N-staging. In the 78 patients, the prevalence of malignant mediastinal LNs was 21%. The accuracy of EUS/EUS-FNA (91%) was significantly higher than that of CT (71%). The negative predictive value of EUS/EUS-FNA was 90%. In addition, EUS-FNA identified 2 patients as N3 disease in 56 patients without mediastinal LN involvement on CT. Conclusions: EUS/EUS-FNA gave more accurate N-staging in patients with possibly resectable NSCLC than CT, and is thus considered to be useful to determine the optimal treatment strategy.

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Section: Discussionmentioning

confidence: 99%

“…However, the anterior mediastinum (level 3A) is still inaccessible even using EBUS or mediastinoscopy. For this area, another option, such as thoracoscopy and TEMLA, should therefore be considered [3,30]. …”

Section: Discussionmentioning

confidence: 99%

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

et al. 2009

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“…The advantage for both methods is the reduction of false-negative results because of potential micrometastasis in the removed nodes. In both procedures, a high accuracy between 96% and 98% and NPV between 97% and 99% has been reported [60][61][62].…”

Section: Invasive Techniquesmentioning

confidence: 99%

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

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“…In contrast to other surgical mediastinal sampling methods, TEMLA and VAMLA offer complete lymphadenectomy (17). However, the high rate of complications (6.0-13.2%) make use of both VAMLA and TEMLA unpopular given development of endoscopic techniques with comparable diagnostic yield but much better safety profile and shorter procedure duration (11,12,17,18).…”

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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The transcervical extended mediastinal lymphadenectomy versus cervical mediastinoscopy in non-small cell lung cancer staging

Abstract: 1. The sensitivity and the NPV of the TEMLA in detecting mediastinal metastases in NSCLC are significantly greater than those of cervical mediastinoscopy. 2. The invasiveness of TEMLA and mediastinoscopy does not significantly differ, except for the postoperative pain.

Cited by 58 publications

References 10 publications

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Mediastinal Lymph Node Staging in Potentially Resectable Non-Small Cell Lung Cancer: A Prospective Comparison of CT and EUS/EUS-FNA

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

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

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