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Ann Thorac Surg 1985;40:57-59
© 1985 The Society of Thoracic Surgeons

Articles

The Value of Computed Tomography in Staging Bronchogenic Carcinoma: A Changing Role for Mediastinoscopy

Walter G. Graves, M.D., Maj, Manuel J. Martinez, M.D., Ltc*, Preston L. Carter, M.D., Col, Michael J. Barry, M.D., Col, John S. Clarke, M.D., Col

Thoracic Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, WA, and the Thoracic and Cardiovascular Surgery Service, Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, CA

Accepted for publication December 7, 1984.

* Address reprint requests to Dr. Martinez, Thoracic and Cardiovascular Surgery Service, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700

Forty-one patients underwent operative staging for bronchogenic carcinoma following computed tomography of the mediastinum between August, 1982, and March, 1984. Twenty-seven patients were classified as Stage I preoperatively; in 2 of them, positive mediastinal nodes were found at thoracotomy. For the 14 patients in whom positive nodes had been identified by computed tomographic (CT) scanning, staging was unchanged as a result of the findings at mediastinoscopy or thoracotomy or both. In this series, computed tomography had a sensitivity of 89%, a specificity of 100%, and an overall accuracy rate of 95%. We conclude that mediastinoscopy is not needed in patients without evidence of mediastinal nodal enlargement by CT scan; when performed, it should be guided toward those nodes identified as positive.




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