The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe

Jiao, Xiaolong; Magistrelli, Prospero; Goldstraw, Peter

doi:10.1016/s1010-7940(96)01083-4

Cited by 26 publications

(8 citation statements)

References 15 publications

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“…The overall sensitivity for detecting mediastinal lymph node involvement of the anterior mediastinum is reported to be 63% to 86%, but when coupled with a standard cervical mediastinoscopy, the combined sensitivity raises significantly to 87%. 36,37 ENDOBRONCHIAL ULTRASOUND-GUIDED TBNA Currently there are 2 types of EBUS available for clinical practice. For optimal imaging, the miniaturized 20 MHz radial probe fitted with a catheter that carries a water-inflatable balloon at the tip allows visualization of detailed images of the surrounding structures as well as the bronchial wall structure.…”

Section: Anterior Mediastinotomymentioning

confidence: 99%

Staging Non–Small Cell Lung Cancer

Yasufuku

Keshavjee

2010

Clinical Pulmonary Medicine

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During the staging process of non-small cell lung cancer (NSCLC), accurate mediastinal lymph node staging is a critical factor which affects patient outcome. Cervical mediastinoscopy has been considered the "Gold Standard" for mediastinal staging in NSCLC. Recently, there is an increasing interest in minimally invasive endoscopic mediastinal staging techniques. In particular, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) uses ultrasound technology built into a flexible bronchoscope for real-time ultrasound-guided sampling of mediastinal lymph nodes. EBUS-TBNA has access to all of the mediastinal lymph nodes accessible by mediastinoscopy as well as N1 nodes. Based on the current evidence, EBUS-TBNA represents a minimally invasive procedure as an alternative to mediastinoscopy for mediastinal staging of NSCLC with discrete N2 or N3 lymph node enlargement, provided negative results are confirmed by surgical staging. Until we have the final results of the controlled comparative study of EBUS-TBNA versus mediastinoscopy, it is uncertain whether EBUS-TBNA will completely replace mediastinoscopy. It will also be important to incorporate new minimally invasive endoscopic techniques in the algorithm of lung cancer staging. EBUS-TBNA may be considered for initial staging of NSCLC in patients with suspicious mediastinal lymph nodes on noninvasive staging, provided negative results are confirmed by surgical staging. This will allow mediastinoscopy to be reserved for restaging after induction treatment. EBUS-TBNA also has potential for providing molecular diagnosis.

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Section: Anterior Mediastinotomymentioning

confidence: 99%

Staging Non–Small Cell Lung Cancer

Yasufuku

Keshavjee

2010

Clinical Pulmonary Medicine

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“…The reliability of this procedure has not been fully investigated, probably because of the difficulties in the visualization of the anterior mediastinum and its lack of use in clinical practice. There are only few reports recently on the value of the procedure combined with cervical mediastinoscopy 37,38 . The overall sensitivity for detecting mediastinal lymph node involvement of the anterior mediastinum is reported to be 63–86%, but when it is coupled with a standard cervical mediastinoscopy, the combined sensitivity raises significantly to 87% 39–41 .…”

Section: Techniques Of Invasive Mediastinal Stagingmentioning

confidence: 99%

“…There are only few reports recently on the value of the procedure combined with cervical mediastinoscopy. 37,38 The overall sensitivity for detecting mediastinal lymph node involvement of the anterior mediastinum is reported to be 63-86%, but when it is coupled with a standard cervical mediastinoscopy, the combined sensitivity raises significantly to 87%. [39][40][41] The reported complications are very low, which include superficial wound infections, bleeding and pneumothoraces.…”

Section: Anterior Mediastinotomymentioning

confidence: 99%

Staging and diagnosis of non‐small cell lung cancer: Invasive modalities

Yasufuku

Fujisawa

2007

Respirology

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Staging and diagnosis of non-small cell lung cancer: Invasive modalities YASUFUKU K, FUJISAWA T. Respirology 2007; 12: [173][174][175][176][177][178][179][180][181][182][183] Abstract: During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the more important factors that affects patient outcome. Several different invasive and non-invasive modalities exist for mediastinal staging. Invasive tests include mediastinoscopy, thoracoscopy, transbronchial needle aspiration, transthoracic needle aspiration, endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration. Each of the invasive tests has limitations for particular locations, has particular risks and requires specific skills. Invasive tests are often used to confirm the staging of lung cancer, but are also used to obtain a diagnosis. The best approach depends upon the clinician's assessment of the patient. This review discusses the invasive staging tests that are available, with particular emphasis on newer modalities, especially endobronchial ultrasound-guided transbronchial needle aspiration. In addition, the current advances in diagnostic bronchoscopy for lung cancer will be reviewed.

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“…In the series reported by our institution [31], LAM was combined with CMed in 85 patients, all with left upper lobe lung cancers. LAM was performed first to undertake an assessment of resectability, i.e.…”

Section: Surgical Techniquesmentioning

confidence: 99%

The Future in Diagnosis and Staging of Lung Cancer

Catarino

Goldstraw²

2006

Respiration

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Surgical techniques remain central to the diagnosis and staging of lung cancer. Clinical situations which invoke the role of surgery include the diagnosis of solitary pulmonary masses, staging of the mediastinum, restaging of the mediastinum and the assessment of resectability. The techniques available include cervical mediastinoscopy, anterior mediastinotomy, video-assisted thoracoscopy and different procedures for intra-operative mediastinal lymph node assessment including systematic nodal dissection, lobe-specific nodal dissection and sentinel node mapping. The staging of lung cancer is continuously evolving as technological advances combine with clinical advances to better stratify patients into treatment and prognostic categories and alter pre-operative investigation algorithms. Although most of the surgical techniques have been around for many years, it is their application in future which is likely to change. The increasing use of positron emission tomography/computed tomography fusion imaging is raising the proportion of patients being shown to have additional lesions that could contraindicate surgical treatment but which require tissue confirmation to exclude a false-positive examination. Many such lesions are amenable to the expanding techniques available to the interventional endoscopist. The relationship between the surgeon and the endoscopist must become closer to ensure that the appropriate technique is used at each point in the patient’s pathway. The future of surgical techniques will be driven by: (1) developments in screening and imaging, with a likelihood that more early stage cancers will present and may be amenable to minimally invasive surgical approaches with the possibility of a role for robotics and nanotechnology; (2) improvements in neoadjuvant therapies which will demand flawless mediastinal staging and restaging; (3) advances in molecular biology which, whilst currently requiring that surgery provide samples of tumour and lymph node tissue to fully characterize the disease, do hold the promise that ever smaller amounts of tissue will be required and that eventually the genetic fingerprint will provide a biological ultrastaging to perhaps supersede anatomical staging.

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The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe

Abstract: We conclude that this combined approach is better than using either technique alone in the preoperative staging and the evaluation of resectability of left upper lobe tumours.

Cited by 26 publications

References 15 publications

Staging Non–Small Cell Lung Cancer

Staging Non–Small Cell Lung Cancer

Staging and diagnosis of non‐small cell lung cancer: Invasive modalities

The Future in Diagnosis and Staging of Lung Cancer

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