Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer
01 Jan 2010-
About: The article was published on 2010-01-01 and is currently open access. It has received 17 citations till now. The article focuses on the topics: Mediastinoscopy & Lung cancer.
Citations
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TL;DR: In daily practice, the intended curative resection for lung cancer cannot be considered complete in the majority of patients, because of an incomplete lymph node dissection according to the current guidelines of the ESTS.
Abstract: OBJECTIVES: In patients with early-stage non-small cell lung cancer, surgery offers the best chance of cure when a complete resection, including mediastinal lymph node dissection, is performed. A definition for complete resection and guidelines for intra-operative lymph node staging have been published, but it is unclear whether these guidelines are followed in daily practice. The goal of this study was to evaluate the extent of mediastinal lymph node dissection routinely performed during lung cancer surgery, and hereby the completeness of resection according to the guidelines of the European Society of Thoracic Surgery (ESTS) for intra-operative lymph node staging. METHODS: In a retrospective cohort study, the extent of mediastinal lymph node dissection was evaluated in 216 patients who underwent surgery for lung cancer with a curative intent in four different hospitals, three community hospitals and one university hospital. Data regarding clinical staging, the type of resection and extent of lymph node dissection were collected from both the patient's medical record and the surgical and pathology report. Based on histology, location and side of the primary tumour, the extent of mediastinal dissection was compared with the ESTS guidelines for intra-operative lymph node staging. RESULTS: According to the surgical report interlobar and hilar lymph nodes were dissected in one-third of patients. A mediastinal lymph node exploration was performed in 75% of patients; however, subcarinal lymph nodes were dissected in <50% of patients and at least three mediastinal lymph node stations were investigated in 36% of patients. In 35% of the mediastinal stations explored, lymph nodes were sampled instead of a complete dissection of the entire station. A complete lymph node dissection according to the guidelines of the ESTS was performed in 4% of patients. Despite an incomplete dissection unexpected mediastinal lymph nodes were found in 5% of patients. CONCLUSIONS: In daily practice, the intended curative resection for lung cancer cannot be considered complete in the majority of patients, because of an incomplete lymph node dissection according to the current guidelines of the ESTS.
53 citations
TL;DR: The EB US-miniforceps biopsy is an effective, safe, and efficient method of obtaining histopathologic specimens from mediastinal and hilar abnormalities in patients with a low likelihood of non-small cell lung carcinoma, particularly when the technique is combined with EBUS-TBNA.
51 citations
TL;DR: EBUS-TBNA might be a feasible option for most patients with NSCLC for whom histologic assessment of the mediastinum is necessary, and the rates of nondiagnostic and false-negative biopsy findings using EBUS- TBNA were low.
43 citations
TL;DR: There is opportunity for improvement in the thoroughness, accuracy, and timeliness of preoperative evaluation of suspected lung cancer patients in this community cohort.
26 citations
TL;DR: If mediastinal staging is improved, more patients should receive optimal treatment and might survive longer and the current post hoc analysis evaluated survival in ASTER.
Abstract: Five-Year Survival After Endosonography vs Mediastinoscopy for Mediastinal Nodal Staging of Lung Cancer Lung cancer accounts for the highest cancer-related mortality rate worldwide.1 Accurate mediastinal nodal staging is crucial in the management of non–small cell lung cancer (NSCLC) because it directs therapy and has prognostic value.2,3 The Assessment of Surgical Staging vs Endosonographic Ultrasound in Lung Cancer (ASTER) trial compared mediastinoscopy (surgical staging) with an endosonographic staging strategy (which combined the use of endobronchial and transesophageal ultrasound followed by mediastinoscopy if negative).4 The endosonographic strategy was significantly more sensitive for diagnosing mediastinal nodal metastases than surgical staging (94% endosonographic strategy vs 79% surgical strategy). If mediastinal staging is improved, more patients should receive optimal treatment and might survive longer. The current post hoc analysis evaluated survival in ASTER.
21 citations
References
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TL;DR: A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination, and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake.
Abstract: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.
52,293 citations
TL;DR: Recommendations for classifying regional lymph node stations for lung cancer staging have been adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer, and provides for consistent, reproducible, lymph node mapping that is compatible with the international staging system for Lung cancer.
1,375 citations
TL;DR: In patients with extensive mediastinal infiltration, invasive staging is not needed and patients with a peripheral clinical stage I NSCLC do not usually need invasive confirmation of mediastsinal nodes unless a PET scan finding is positive in the nodes.
672 citations
TL;DR: The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer (NSCLC), where the authors developed guidelines for definitions and the surgical procedures of intraoperative lymph nodes staging, and the pathologic evaluation of resected lymph nodes in patients with NSCLC.
Abstract: The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. The objective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and the pathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on the subjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus. Systematic nodal dissection is recommended in all cases to ensure complete resection. Lobe-specific systematic nodal dissection is acceptable for peripheral squamous T1 tumors, if hilar and interlobar nodes are negative on frozen section studies; it implies removal of, at least, three hilar and interlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies and sampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resected separately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does not detect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolated tumor cells in hematoxylin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patients with these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging and pathologic evaluation, and improve pathologic staging, which will help decide on the best adjuvant therapy.
579 citations
TL;DR: EBUS-TBNA was an accurate, safe and cost-effective tool in lung cancer staging and the selection of patients who had positive results of suspected lymph node metastasis in CT or PET may improve the sensitivity of EBUS- TBNA.
545 citations