- Email: [email protected]
Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer
260
is recommended for safe and rapid assessment of the value of MR in bronchial carcinoma staging. Incidence of P u l m o n a ~ N o d u l e s Detected by Computed Tomography in Patients with Bronchial Carcinoma. Mitchell, D.M., Shah, S.H., Edwards, D. et al. University College Hospital, London WCIE 6AU, United Kingdom. Clin. Radiol. 37: 151-152, 1986. Computed tomography (CT) is more sensitive in detecting pulmonary nodules than conventional chest radiography. The incidence of pulmonary nodules on thoracic CT scans, not visible on chest radiographs, in patients with small-cell carcinoma of the bronchus (SCCB) was 27%, and in patients with non-small-cell carcinoma (non-SCCB) the incidence was 28%. Some of these nodules may be malignant. This has implications for the surgical staging of patients with lung cancer in the United Kingdom, where there is a lower incidence of benign granulomatous nodules than in the USA. Prospective Evaluation of Mediastinoscopy for Assessment of Carcinoma of the Lung. Luke, W.P., Pearson, F.G., Todd, T.R.J. et al. Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ont. M5G IL7, Canada. J. Thorac. Cardiovasc. Surg. 91: 53-56, 1986. Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500 patients admitted to the Thoracic Surgical Service of the Toronto General Hospital with the diagnosis of carcinoma of the lung. In 144 cases, concomitant anterior mediastinoscopy was also performed. Abnormal mediastinal nodes were found in 296 (29.6%). The overall complication rate was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with small cell undifferentiated carcinoma, 31% with large cell undifferentiated carcinoma, and 12% with bronchoalveolar carcinoma. Abnormal mediast inal nodes were found with equal frequency in right- and leftsided tumors and occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors, and 17% of lower lobe tumors. Of the 704 patients having negative results of mediastinoscopy, 590 were subjected to thoracotomy. Ninety-three percent underwent resection (85% curative, 7% palliative) and 7% had unresectable tumors. Of the resections, 20% were pneumonectomies. At thoracotomy, 52 of the 590 patients with negative mediastinoscopy were selected for thoracotomy. Eighty-six percent had resectable lesions (67% curative, 18% palliative) and 14% unresectable. The pneumonectomy rate in
this group WaS 35%. These current data support our previous opinion that routine mediastinoscopy can be done with negligible morbidity and provides essential information for the classification and management of cancer of the lung. Role of Mediastinoscopy in Pretreatment Staging of Patients with Primary Lung Cancer. Coughlin, M., Deslauriers, J., Beaulieu, M. et al. Division of Thoracic Surgery, Le Centre de Penumologie de Laval, Quebec, PQ GIV 4G5, Canada. Ann. Thorac. Surg. 40: 556-560, 1985~ Since the introduction of mediastinoscopy, there has been a great deal of discussion regarding indications for this technique and the significance of positive findings. We undertook this study to determine the role of clinical staging and the value of routine mediastinoscopy in the treatment selection of patients with primary lung cancer. From 1975 to 1983, 1,259 consecutive patients with proven and operable lung cancer underwent preresection mediastinoscopy. Nodes were sampled at three levels, and findings were recorded by location, invasiveness, and histology. There were no operative deaths, but 3 patients had a major complication.Mediastinoscopy was positive in 339 (27%) patients and negative in 920 (73%). In the group with positive findings, 303 patients had no operation because a curative resection was not possible (extranodal metastases, 180; location, 76; histology, 47). No patient survived 5 years, and only 4% survived 2 years. Of the 36 patients considered to have operable disease, 28 underwent resection with a projected 5-year survival of 18%. In the group with negative findings, 89% had a curative resection with a hospital mortality of 3.2% and 5-year survival of 53%. When results of mediastinoscopy were correlated with findings at thoracotomy, the sensitivity of the test was 93% on nodes in the superior mediastinum and the specificity, 100%. This study shows that mediastinoscopy is safe and is an accurate indicator of the presence or absence of tumor in superior mediastinal nodes. If positive nodes are found, a curative resection is generally not possible, thoracotomy is avoided, and the overall survival is low. Comparative Merits of Conventional, Computed Tomographic, and Magnetic Resonance Imaging in Assessing Mediastinal Involvement in Surg~cally Confirmed Lung Carcinoma. Martini, N., Heelan, R., Westcott, J. et al. Memorial Sloan-Kettering Cancer Center, New York, NY 10021, U . S . A . J . Thorac. Cardiovasc. Surg. 90: 639-648, 1985. Thirty-four patients with operable malignant tumors of the lung had computed tomography and magnetic resonance imaging of
is recommended for safe and rapid assessment of the value of MR in bronchial carcinoma staging. Incidence of P u l m o n a ~ N o d u l e s Detected by Computed Tomography in Patients with Bronchial Carcinoma. Mitchell, D.M., Shah, S.H., Edwards, D. et al. University College Hospital, London WCIE 6AU, United Kingdom. Clin. Radiol. 37: 151-152, 1986. Computed tomography (CT) is more sensitive in detecting pulmonary nodules than conventional chest radiography. The incidence of pulmonary nodules on thoracic CT scans, not visible on chest radiographs, in patients with small-cell carcinoma of the bronchus (SCCB) was 27%, and in patients with non-small-cell carcinoma (non-SCCB) the incidence was 28%. Some of these nodules may be malignant. This has implications for the surgical staging of patients with lung cancer in the United Kingdom, where there is a lower incidence of benign granulomatous nodules than in the USA. Prospective Evaluation of Mediastinoscopy for Assessment of Carcinoma of the Lung. Luke, W.P., Pearson, F.G., Todd, T.R.J. et al. Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ont. M5G IL7, Canada. J. Thorac. Cardiovasc. Surg. 91: 53-56, 1986. Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500 patients admitted to the Thoracic Surgical Service of the Toronto General Hospital with the diagnosis of carcinoma of the lung. In 144 cases, concomitant anterior mediastinoscopy was also performed. Abnormal mediastinal nodes were found in 296 (29.6%). The overall complication rate was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with small cell undifferentiated carcinoma, 31% with large cell undifferentiated carcinoma, and 12% with bronchoalveolar carcinoma. Abnormal mediast inal nodes were found with equal frequency in right- and leftsided tumors and occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors, and 17% of lower lobe tumors. Of the 704 patients having negative results of mediastinoscopy, 590 were subjected to thoracotomy. Ninety-three percent underwent resection (85% curative, 7% palliative) and 7% had unresectable tumors. Of the resections, 20% were pneumonectomies. At thoracotomy, 52 of the 590 patients with negative mediastinoscopy were selected for thoracotomy. Eighty-six percent had resectable lesions (67% curative, 18% palliative) and 14% unresectable. The pneumonectomy rate in
this group WaS 35%. These current data support our previous opinion that routine mediastinoscopy can be done with negligible morbidity and provides essential information for the classification and management of cancer of the lung. Role of Mediastinoscopy in Pretreatment Staging of Patients with Primary Lung Cancer. Coughlin, M., Deslauriers, J., Beaulieu, M. et al. Division of Thoracic Surgery, Le Centre de Penumologie de Laval, Quebec, PQ GIV 4G5, Canada. Ann. Thorac. Surg. 40: 556-560, 1985~ Since the introduction of mediastinoscopy, there has been a great deal of discussion regarding indications for this technique and the significance of positive findings. We undertook this study to determine the role of clinical staging and the value of routine mediastinoscopy in the treatment selection of patients with primary lung cancer. From 1975 to 1983, 1,259 consecutive patients with proven and operable lung cancer underwent preresection mediastinoscopy. Nodes were sampled at three levels, and findings were recorded by location, invasiveness, and histology. There were no operative deaths, but 3 patients had a major complication.Mediastinoscopy was positive in 339 (27%) patients and negative in 920 (73%). In the group with positive findings, 303 patients had no operation because a curative resection was not possible (extranodal metastases, 180; location, 76; histology, 47). No patient survived 5 years, and only 4% survived 2 years. Of the 36 patients considered to have operable disease, 28 underwent resection with a projected 5-year survival of 18%. In the group with negative findings, 89% had a curative resection with a hospital mortality of 3.2% and 5-year survival of 53%. When results of mediastinoscopy were correlated with findings at thoracotomy, the sensitivity of the test was 93% on nodes in the superior mediastinum and the specificity, 100%. This study shows that mediastinoscopy is safe and is an accurate indicator of the presence or absence of tumor in superior mediastinal nodes. If positive nodes are found, a curative resection is generally not possible, thoracotomy is avoided, and the overall survival is low. Comparative Merits of Conventional, Computed Tomographic, and Magnetic Resonance Imaging in Assessing Mediastinal Involvement in Surg~cally Confirmed Lung Carcinoma. Martini, N., Heelan, R., Westcott, J. et al. Memorial Sloan-Kettering Cancer Center, New York, NY 10021, U . S . A . J . Thorac. Cardiovasc. Surg. 90: 639-648, 1985. Thirty-four patients with operable malignant tumors of the lung had computed tomography and magnetic resonance imaging of