The Annals of Thoracic Surgery, Vol 48, 565-567, Copyright © 1989 by The Society of Thoracic Surgeons
Efficacy and benefit of mediastinal computed tomography as a selection method for mediastinoscopy
M Thermann, R Bluemm, U Schroeder, E Wassmuth and R Dohmann
Department of General and Thoracic Surgery, Community Hospital Bielefeld Center, Academic Teaching Hospital, Federal Republic of Germany.
In 95 consecutive patients with proven or suspected bronchial carcinoma,
computed tomographic evaluation of the upper mediastinum for N2 disease was
performed prospectively. Patients with positive results underwent
mediastinoscopy. Patients with perinodal N2 or N3 disease at
mediastinoscopy were not considered candidates for operation. The
mediastinum was declared negative only when intraoperative mediastinal
lymph node dissection showed tumor-free nodes. Of the 95 patients, 12 had
benign lesions, 14 were excluded from further evaluation because the lymph
node status of the mediastinum was not proven intraoperatively, and 6
others were excluded from the final evaluation because of violation of the
protocol. Twenty-two of the 75 remaining patients had a positive computed
tomographic scan and underwent mediastinoscopy. Fourteen patients with
positive results were considered to have inoperable disease. Fifty-three
patients (70.7%) did not undergo mediastinoscopy. We performed seven
probably incomplete resections, two for palliative reasons, and two
thoracotomies without resection in patients with N2 disease. A policy of
routine mediastinoscopy would have prevented only 5% of the thoracotomies
performed in patients with lung cancer.
