| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1999;68:1154-1158
© 1999 The Society of Thoracic Surgeons
a Section of Surgical SciencesVanderbilt University Hospital, Nashville, Tennessee, USA
b Department of Cardiac and Thoracic Surgery, Vanderbilt University Hospital, Nashville, Tennessee, USA
c Department of Radiology, Vanderbilt University Hospital, Nashville, Tennessee, USA
Address reprint requests to Dr Roberts, Department of Cardiac and Thoracic Surgery, 2986 The Vanderbilt Clinic, Vanderbilt University Hospital, Nashville, TN 37232
e-mail: bob.roberts{at}mcmail.vanderbilt.edu
Presented at the Forty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 12–14, 1998.
Background. More accurate staging at the time of initial presentation could improve design of clinical trials and avoid inappropriate surgical decisions in individual patients. Preresection staging of patients with non-small cell lung cancer (NSCLC) is not straightforward, especially in patients with negative mediastinal nodes. The purpose of this study was to compare the results of radiologic, thoracoscopic, and pathologic staging in patients with NSCLC and negative mediastinoscopy.
Methods. All patients with NSCLC underwent computed tomographic (CT) scanning before surgical staging with mediastinoscopy. Patients with negative mediastinoscopy then underwent thoracoscopic staging with examination of pleural surfaces, and identification of T (visceral and parietal pleural invasion, sampling of pleural fluid, and pleural lavage) and N (intraparenchymal and inferior mediastinal nodal sampling, if possible) stage descriptors before resection.
Results. Thoracoscopy was more accurate than CT scanning in the staging of 50 patients with early lung cancer (stages IA, IB, IIA, and IIB), especially as regards T stage. Further, thoracoscopic examination ruled out malignant pleural effusions in 7 (14%) patients with radiologically obvious effusions, and identified radiologically silent malignant pleural effusions in 3 (6%) patients. Chest wall invasion was accurately identified at thoracoscopy in most patients. Finally, 3 patients with T1 lower lobe lesions and negative mediastinoscopy were found to have involvement of inferior mediastinal nodes (level 8 or 9) at thoracoscopy. However, thoracoscopy did not allow sampling of aortopulmonary window nodes in some patients with bulky left upper lobe lesions.
Conclusions. Errors in thoracoscopic staging resulted in no inappropriate operations. However, errors in CT staging would have resulted in operations unlikely to help the patients, or would have inappropriately excluded patients from surgery. Thoracoscopic staging was more accurate than CT staging in this cohort of patients with NSCLC and negative mediastinoscopy.
This article has been cited by other articles:
|
|
 |
|
  P. Solli and L. Spaggiari Indications and Developments of Video-Assisted Thoracic Surgery in the Treatment of Lung Cancer Oncologist, October 1, 2007; 12(10): 1205 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. C. Detterbeck, M. A. Jantz, M. Wallace, J. Vansteenkiste, and G. A. Silvestri Invasive Mediastinal Staging of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 202S - 220S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Downey, T. Akhurst, M. Gonen, B. Park, and V. Rusch Fluorine-18 fluorodeoxyglucose positron emission tomographic maximal standardized uptake value predicts survival independent of clinical but not pathologic TNM staging of resected non-small cell lung cancer J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1419 - 1427. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W A H Wallace, H M Monaghan, D M Salter, M A Gibbons, and K M Skwarski Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology J. Clin. Pathol., April 1, 2007; 60(4): 388 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Bodner, H. Wykypiel, A. Greiner, W. Kirchmayr, M. C. Freund, R. Margreiter, and T. Schmid Early experience with robot-assisted surgery for mediastinal masses Ann. Thorac. Surg., July 1, 2004; 78(1): 259 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Pfister, D. H. Johnson, C. G. Azzoli, W. Sause, T. J. Smith, S. Baker Jr, J. Olak, D. Stover, J. R. Strawn, A. T. Turrisi, et al. American Society of Clinical Oncology Treatment of Unresectable Non-Small-Cell Lung Cancer Guideline: Update 2003 J. Clin. Oncol., January 15, 2004; 22(2): 330 - 353. [Full Text] [PDF]
|
|
|
|
|
|
C. E. Reed General thoracic surgery and the Southern Thoracic Surgical Association: the second 25 years Ann. Thorac. Surg., November 1, 2003; 76(90050): S14 - 16. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Cetinkaya, A. Turna, P. Yildiz, R. Dodurgali, M. A. Bedirhan, A. Gurses, and V. Yilmaz Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 1000 - 1005. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. C. Gupta, J. S. Rogers, G. M. Graeber, J. L. Gregory, U. Waheed, D. Mullet, and M. Atkins Clinical Role of F-18 Fluorodeoxyglucose Positron Emission Tomography Imaging in Patients With Lung Cancer and Suspected Malignant Pleural Effusion Chest, December 1, 2002; 122(6): 1918 - 1924. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R L Prosst, S Winkler, E Boehm, and J Gahlen Thoracoscopic fluorescence diagnosis (TFD) of pleural malignancies: experimental studies Thorax, December 1, 2002; 57(12): 1005 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Eggeling, T. Martin, J. Bottger, T. Beinert, and K. Gellert Invasive staging of non-small cell lung cancer - a prospective study Eur. J. Cardiothorac. Surg., November 1, 2002; 22(5): 679 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. E. Schmidt, E. A. Woltering, W. R. Webb, O. M. Garcia, J. E. Cohen, and M. H. Rozans Sentinel nodal assessment in patients with carcinoma of the lung Ann. Thorac. Surg., September 1, 2002; 74(3): 870 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.J. Poncelet, M. Lonneux, E. Coche, B. Weynand, and Ph. Noirhomme PET-FDG scan enhances but does not replace preoperative surgical staging in non-small cell lung carcinoma Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 468 - 475. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
