Showing papers on "Mediastinoscopy published in 1987"
TL;DR: The author has found extended cervical mediastinoscopy extremely valuable in staging lung carcinoma with regard to level V and VI lymph node involvement if a standard cervical mediASTinoscopy fails to demonstrate metastatic disease and a CT scan suggests subaortic lymph nodes involvement.
170 citations
TL;DR: Computed tomography, magnetic resonance imaging, chest roentgenography, and mediastinoscopy were compared prospectively as staging modalities to assess mediastinal node status in 84 patients with presumed operable bronchogenic carcinoma and mediastsinoscopy was recommended as the most accurate staging investigation.
148 citations
TL;DR: The value of invasive staging of the mediastinum is its greater accuracy in assessing the operability of lung cancer compared to noninvasive techniques, and it is continued to use mediastinoscopy routinely in evaluating the mediastsinum prior to advising thoracotomy for resection in the management of Lung cancer.
68 citations
TL;DR: As long as nodal size remains the sole criterion in the detection of metastatic mediastinal lymphadenopathy, MR imaging is unlikely to enable better interpretations than CT scanning.
Abstract: Magnetic resonance (MR) imaging and computed tomography (CT) were compared in a prospective study of 48 patients for the detection of metastatic mediastinal lymphadenopathy from bronchogenic carcinoma. The images were interpreted by three experienced radiologists using a five-point rating scale, enabling receiver operating characteristic (ROC) analysis. Imaging results were evaluated against "truth" data based on analysis of surgical specimens from mediastinoscopy and thoracotomy. All MR images were cardiac gated to reduce cardiac motion artifacts in the mediastinum. MR and CT both performed well, as indicated by similar areas under the ROC curves of 0.779 +/- 0.039 for MR imaging and 0.781 +/- 0.038 for CT scanning. No strong correlation between nodal size and metastatic involvement could be found for either MR or CT results. As long as nodal size remains the sole criterion in the detection of metastatic mediastinal lymphadenopathy, MR imaging is unlikely to enable better interpretations than CT scanning.
64 citations
TL;DR: In this paper, the authors conducted computed tomographic examinations of the chest in 171 patients with lung cancer whose disease was subsequently surgically staged; routine mediastinal exploration was undertaken in all patients undergoing thoracotomy (151), and in 20 patients only anterior mediastinotomy or mediastinoscopy was performed.
63 citations
TL;DR: Mediastinoscopy is useful in the diagnosis of anterior mediastinal masses, and may eliminate unnecessary thoracotomy, especially when a gallium scan is positive.
34 citations
TL;DR: En bloc resection of chest wall and lung for primary non-small cell bronchogenic carcinoma with chest wall invasion can be performed with a reasonable expectation of long-term survival if lymph nodes are not metastatically involved.
23 citations
TL;DR: The records of 30 patients with mediastinal masses were reviewed to evaluate the signs, symptoms, and preoperative tests that were most useful in diagnosing and localizing the masses and found that benign tumors were more common than malignant tumors.
18 citations
TL;DR: A group of patients showing no, or at the most, three enlarged mediastinal lymph nodes on CT may be considered as candidates for surgery even without mediastinoscopy, so that it cannot be omitted out of hand.
Abstract: In order to evaluate the role of CT scan and bone scan in staging patients with non-small-cell lung cancer presumably indicated for surgery, 70 consecutive patients who underwent thoracotomy were reviewed. Most of them received mediastinal and multi-organ (brain, liver and adrenal) CT scans and a bone scan. In the most recent 40 of the 70 patients, CT findings of the mediastinal lymph nodes were compared to the pathology following complete sampling. The overall accuracy of the mediastinal CT was 60.0 per cent (12 true positive and 12 true negative), but the negative predictable value was 12/(12 + 3) or 80.0 per cent, whereas 3 were false negatives though they showed an acceptable postoperative course. Sixteen out of 21 patients with one, or at the most, three enlarged nodes detected on CT also did well postoperatively and retrospectively, were considered not to have required mediastinoscopy. A group of patients showing no, or at the most, three enlarged mediastinal lymph nodes on CT may be considered as candidates for surgery even without mediastinoscopy. Multi-organ survey by means of CT was believed cost-ineffective and omittable. Bone scan however, retrospectively detected three true positives among 20 patients with a positive uptake, so that it cannot be omitted out of hand, though further examination of this point is required.
16 citations
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TL;DR: One hundred sixty patients had preoperative mediastinoscopy, resection of the primary tumor, and complete mediastinal lymphadenectomy for non-small-cell carcinoma of the lung and postoperative staging based on histologic examination of the specimen of the lungs and mediastinum found patients in stage I, 28 in stage II, and 73 in stage III had mediastine node involvement.
14 citations
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TL;DR: The incidence of mediastinal node involvement of T1 non-small-cell bronchogenic carcinomas was determined and was found to be highest among patients with large-cell anaplastic carcinomas, followed by adenocarcinomas and squamous cell carcinomas.
Abstract: The incidence of mediastinal node involvement of T1 non-small-cell bronchogenic carcinomas was determined in 262 patients for the period June 1981 to January 1986. All patients underwent mediastinoscopy as part of their evaluation. Thirty-five patients (13%) had clinical primary T1 lesions. There were 17 adenocarcinomas, 10 squamous cell carcinomas, 6 large-cell anaplastic carcinomas and 2 bronchoalveolar carcinomas. Five patients had node involvement at mediastinoscopy: two had large-cell anaplastic carcinomas and one was a squamous cell carcinoma. Thoracotomy in the remaining 30 patients revealed 2 with pleural metastases, 1 with left upper lobe adenocarcinoma with metastases to the subaortic nodal area (not assessed by cervical mediastinoscopy). The other patients underwent resection, for a resectability rate of 90%. Therefore the overall incidence of mediastinal node involvement in this series was 17% (6 of 35) and was found to be highest among patients with large-cell anaplastic carcinomas (2 of 6), followed by adenocarcinomas (3 of 19) and squamous cell carcinomas (1 of 10). The larger number of large-cell anaplastic carcinomas in this series probably accounts for the higher incidence of N2 disease found compared with that of previous studies in the literature. Accordingly, preoperative mediastinal staging is recommended for all T1 large-cell anaplastic carcinomas and adenocarcinomas and for suspicious lesions of undetermined histology.
TL;DR: The ease and safety of TNB may make it the preferred initial procedure for diagnosing and staging patients with mediastinal masses of unknown etiology.
Abstract: TNB of hilar and mediastinal masses is both safe and useful. It has a high diagnostic yield, can be performed in practically all areas of the mediastinum, and appears to be no more hazardous than needle biopsy of the lung. In healthy patients, it can be performed as an outpatient procedure. TNB makes it possible to avoid surgery and mediastinoscopy in patients with unresectable malignant neoplasms and in many patients with innocuous benign mediastinal lesions. The ease and safety of TNB may make it the preferred initial procedure for diagnosing and staging patients with mediastinal masses of unknown etiology.
TL;DR: The efficacy of surgical judgments in the management of thoracic lymphoma was studied through review of 34 patients with primary mediastinal lymphomas, 30 patients who needed one or moreThoracic operations after treatment of extrathoracicymphoma, and 5 patients withPrimary lymphocytic infiltrates of the lung.
TL;DR: Nine cases of tuberculosis (TB) were diagnosed among 800 uremic patients, followed-up during 11 years, a prevalence of 1125%, 2.5 times higher than that in the general population, and five patients were cured.
Abstract: Nine cases of tuberculosis (TB) were diagnosed among 800 uremic patients, followed-up during 11 years, a prevalence of 1125%, 2.5 times higher than that in the general population. Six patients (66.7%) had lymph node involvement (4 cervical and 2 mediastinal). Three patients (33.3%) had pulmonary involvement (2 pleuro-pulmonary and 1 bilateral apical pulmonary). Eight patients were undergoing dialysis and 1 was pre-dialytic. The duration of dialysis ranged from 1 to 60 months. Three patients had previously received immunosuppressive drugs for unsuccessful renal transplantation. Daily fever was present in all but one patient; he was asymptomatic and TB was suspected after routine chest radiography. Biopsy was the diagnostic procedure in 7 patients (77.8%), four by direct cervical lymph node biopsy, 2 by mediastinal, performed by mediastinoscopy and 1 by pleural biopsy. In 2 other patients TB was confirmed by the presence of tubercle bacilli; in sputum (1 patient) and in a bronchial flushing specimen (the other patient). Triple therapy was used in all patients (isoniazid and ethambutol in all), plus rifampicin in 8 and streptomycin in 1. One patient had jaundice and another had optical neuritis. Five patients were cured. The other four died during treatment of causes unrelated to TB or its treatment.
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TL;DR: It is concluded that in N2-negative CTs mediastinoscopy can be omitted, while in CT-positive patients histological verification appears to be necessary, and the diagnosis of T3 should be carried out with caution.
Abstract: The value of thoracic computed tomography in the staging of non-small cell bronchogenic carcinoma is evaluated. In 57 patients post thoracotomy and in 8 patients who had undergone mediastinoscopy, the preoperative T and N stages determined by CT were compared with the intraoperative stage. With respect to the T3 stage, 49 CT results out of a total of 57 were correct, 6 were false positive and 2 false negative. This corresponds to a sensitivity of 67% and a specificity of 88%. With respect to the N2 stage, 55 out of 65 results were correct, 8 were false positive and 2 false negative, corresponding to a sensitivity of 87% and a specificity of 84%. We conclude that in N2-negative CTs mediastinoscopy can be omitted, while in CT-positive patients histological verification appears to be necessary. The diagnosis of T3 should be carried out with caution: in doubtful cases surgical exploration is recommended.
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TL;DR: Every patient with pulmonary infiltrates must be subjected to mediationastinoscopy before thoracotomy and should be excluded from operative intervention in the presence of positive mediastinoscopic findings.
Abstract: Over a five-year period, 304 patients with non small cell carcinoma of the lung were evaluated for pulmonary resection. The patients were divided into three groups: 1) 180 patients operated without preoperative mediastinoscopy based on a normal appearing mediastinum on plain chest x-ray; 2) 107 patients with resection of both lung tissue and mediastinal tissue due to localised positive mediastinoscopic findings; 3) 17 patients who were found inoperable either due to poor lung function or diffuse mediastinal seeding. In group 1, 24% were peroperatively found to be inoperable due to mediastinal involvement. The rest were resected and received no further therapy. In group 2, 84 patients were resected and postoperatively irradiated on the mediastinal area. The incidence of bronchopleural fistulae in group 1 was 0.7% and in group 2 16%, and the survival at any period was significantly poorer for group 2 than for group 1. We conclude that every patient with pulmonary infiltrates must be subjected to mediastinoscopy before thoracotomy and should be excluded from operative intervention in the presence of positive mediastinoscopic findings.
TL;DR: Prednisone therapy (30 mg/d) was started, with prompt improvement in the patient's symptoms and resolution of the hypercalcemia.
Abstract: REPORT OF A CASE A 63-year-old man was referred to the Gainesville (Fla) Veterans Administration Medical Center dermatology clinic with a six-month history of asymptomatic papules on his left arm and an enlarging tender nodule on his left leg. He had been referred by his pulmonary physician with a tentative diagnosis of cutaneous sarcoidosis. A diagnosis of systemic sarcoidosis was made one year earlier, when the patient had presented with fatigue, 15-kg weight loss, and hypercalcemia. A left hilar mass was found on chest roentgenogram, and the biopsy of this mass at mediastinoscopy revealed a lymph node with noncaseating granulomas, consistent with sarcoidosis. Special stains and cultures of the biopsy specimen were negative. Prednisone therapy (30 mg/d) was started, with prompt improvement in the patient's symptoms and resolution of the hypercalcemia. No skin lesions had been noted at the time of this initial workup. Five months prior to referral and
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TL;DR: The right latero-tracheal localisation in the middle mediastinum, the small volume and the poorly vascularised features of these tumours allowed complete resection via mediastinoscopy.
Abstract: On the basis of 2 cases of tumour of the intrathoracic vagus nerve, the authors recall the characteristics of these tumours which are rare in this situation. The right latero-tracheal localisation in the middle mediastinum, the small volume and the poorly vascularised features of these tumours allowed complete resection via mediastinoscopy.
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TL;DR: The clinical TNM classification system allows improved exchange of information, is an aid in tumor staging and establishing treatment schedules, assists in assessing prognosis and forms the basis of cancer registration.
Abstract: The clinical TNM classification system allows improved exchange of information, is an aid in tumor staging and establishing treatment schedules, assists in assessing prognosis and forms the basis of cancer registration. New elements in the last edition of classifications are stage T4, which means a tumor invading the mediastinum, the heart, the great vessels, the trachea, the esophagus, vertebral bodies, the carina or the pleural space, and stage N3, which includes mediastinal, contralateral hilar, scalene and supraclavicular lymph node metastases. Both stages rule out surgical treatment. Mediastinoscopy is advised in the case of lymph nodes in thoracic CAT of greater than or equal to 1.5 cm diameter. There is evidence that most peritumoral infiltrations consist in T lymphocytes, presenting the host's immunological reaction against tumor tissue. In the context of tumor staging such phenomena may be of prognostic significance.
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TL;DR: The fibroscopic examination of 180 patients treated for small cell lung carcinoma is studied and two out of 70 patients treated by both chemotherapy and radiotherapy presented normal bronchial endoscopy.
Abstract: The fibroscopic examination of 180 patients treated for small cell lung carcinoma is studied. The fibroscopy permits a good diagnosis in at least 93.3% of cases. In the case of failure a mediastinoscopy or transparietal cytopuncture are indicated. The absence of a correlation between a radiological remission and endoscopic remission justifies an endoscopic control prior to each therapeutic step. After treatment, the endoscopy permits the evaluation of chemotherapeutic and mainly radiotherapeutic bronchial sequellae. Two out of 70 patients treated by both chemotherapy and radiotherapy presented normal bronchial endoscopy.
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TL;DR: The results suggest that, in view of current inconveniences of NMR imaging, the best means for local and regional exploration of primary bronchial cancer preoperatively is combined CT scan and mediastinoscopy.
Abstract: Based on a homogeneous series of 50 cases investigated within less than a week by CT scan and NMR imaging with mediastinoscopic correlation, and in 32 of theses cases with correlation with operative findings, a critical study was carried out of modern imaging methods for detection of mediastinal gland invasion from primary bronchial cancer. Axial mediastinoscopy presented absolute specificity and very high sensitivity (93%) markedly superior to those of CT scan and NMR imaging. The two latter examinations were practically of equal efficacy: sensitivity of NMR (80%) was somewhat higher than that of CT scan (70%) whereas specificity of CT scan was 83% as against 70% for NMR. Lack of efficacy of axial mediastinoscopy was in cases with extra-axial lymphatic extension (anterior mediastinal chains) from primary cancer. These results suggest that, in view of current inconveniences of NMR imaging, the best means for local and regional exploration of primary bronchial cancer preoperatively is combined CT scan and mediastinoscopy. The diagnosis of glandular enlargement of anterior mediastinal lymphatic chains should lead to performance of an anterolateral mediastinoscopy.