Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging

Precise mediastinal lymph node (LN) staging is imperative in otherwise operable non-small cell lung cancer (NSCLC), as it determines subsequent treatment and possible inclusion in a neoadjuvant trial. The roles of mediastinoscopy and computed tomography (CT) remain controversial. To determine the accuracy of current CT scanners, a prospective study was performed. From April 1993 until September 1995, 100 consecutive patients with NSCLC without distant metastases underwent staging by CT and cervical mediastinoscopy. Naruke's map was used for classification, and LNs larger than 1 cm were considered CT positive. There were 91 males and 9 females, with a mean age of 64 (range 45-82) yrs. Fifty nine tumours were central and 41 peripheral, 64 right-sided and 36 left-sided. Thoracotomy with mediastinal LN sampling was performed in 74 patients, nonoperated patients having multilevel stage IIIA or stage IIIB disease. Twenty five (25%) mediastinoscopies were positive and three were false-negative (3%). There were 29 false-positive CT scans and 12 false-negative. Overall sensitivity and specificity of CT were 63 and 57%, respectively, and of mediastinoscopy 89 and 100%, respectively. Positive and negative predictive values of CT were 41 and 77%, respectively, and of mediastinoscopy 100 and 96%, respectively. Accuracy of CT was 59% and of mediastinoscopy 97%. Accuracy of CT was lowest for left-sided and centrally located tumours, and for LN station 7. Even with current computed tomography scanners, sensitivity and specificity remain low. Although overall cost may increase, routine cervical mediastinoscopy is necessary for precise staging of non-small cell lung cancer, and subcarinal lymph nodes should be routinely sampled.

This article has been cited by other articles:

				S. A O'Keeffe, A. McGrath, and G. Wilson An interesting chest radiograph BMJ, September 24, 2008; 337(sep24_2): a1505 - a1505. [Full Text]

				M. De Waele, M. Serra-Mitjans, J. Hendriks, P. Lauwers, J. Belda-Sanchis, P. Van Schil, and R. Rami-Porta Accuracy and survival of repeat mediastinoscopy after induction therapy for non-small cell lung cancer in a combined series of 104 patients Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 824 - 828. [Abstract] [Full Text] [PDF]

				G. Leschber, D. Sperling, W. Klemm, and J. Merk Does video-mediastinoscopy improve the results of conventional mediastinoscopy? Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 289 - 293. [Abstract] [Full Text] [PDF]

				M. Soudack, R. B. Shalom, O. Israel, Y. Ben-Arie, Z. Levy, and D. Gaitini Utility of Sonographically Guided Biopsy in Metabolically Suspected Recurrent Lymphoma J. Ultrasound Med., February 1, 2008; 27(2): 225 - 231. [Abstract] [Full Text] [PDF]

				G. A. Silvestri, M. K. Gould, M. L. Margolis, L. T. Tanoue, D. McCrory, E. Toloza, and F. Detterbeck Noninvasive Staging of Non-small Cell Lung Cancer: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 178S - 201S. [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]

				B.-T. Kim, K. S. Lee, S. S. Shim, J. Y. Choi, O J. Kwon, H. Kim, Y. M. Shim, J. Kim, and S. Kim Stage T1 Non-Small Cell Lung Cancer: Preoperative Mediastinal Nodal Staging with Integrated FDG PET/CT--A Prospective Study Radiology, November 1, 2006; 241(2): 501 - 509. [Abstract] [Full Text] [PDF]

				B. F. Meyers, F. Haddad, B. A. Siegel, J. B. Zoole, R. J. Battafarano, N. Veeramachaneni, J. D. Cooper, and G. A. Patterson Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer J. Thorac. Cardiovasc. Surg., April 1, 2006; 131(4): 822 - 829. [Abstract] [Full Text] [PDF]

				M. De Waele, J. Hendriks, P. Lauwers, P. Ortmanns, W. Vanroelen, A.-M. Morel, P. Germonpre, and P. Van Schil Nodal status at repeat mediastinoscopy determines survival in non-small cell lung cancer with mediastinal nodal involvement, treated by induction therapy Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 240 - 243. [Abstract] [Full Text] [PDF]

				O. Birim, A. P. Kappetein, and A. J.J.C. Bogers Reply Ann. Thorac. Surg., November 1, 2005; 80(5): 1980 - 1981. [Full Text] [PDF]

				J. K. LeBlanc, B. M. Devereaux, T. F. Imperiale, K. Kesler, J. M. DeWitt, O. Cummings, D. Ciaccia, S. Sherman, P. Mathur, D. Conces, et al. Endoscopic Ultrasound in Non-Small Cell Lung Cancer and Negative Mediastinum on Computed Tomography Am. J. Respir. Crit. Care Med., January 15, 2005; 171(2): 177 - 182. [Abstract] [Full Text] [PDF]

				O. Birim, A. P. Kappetein, T. Stijnen, and A. J.J.C. Bogers Meta-Analysis of Positron Emission Tomographic and Computed Tomographic Imaging in Detecting Mediastinal Lymph Node Metastases in Nonsmall Cell Lung Cancer Ann. Thorac. Surg., January 1, 2005; 79(1): 375 - 382. [Abstract] [Full Text] [PDF]

				M. Hurtgen, B. Metzler, G. Friedel, and H. Toomes Mediastinoscopic ultrasonography (MUS) Eur. J. Cardiothorac. Surg., October 1, 2004; 26(4): 842 - 844. [Abstract] [Full Text] [PDF]

				L N Gomersall and S Olson Imaging in lung cancer Imaging, October 1, 2004; 16(1): 1 - 9. [Abstract] [Full Text] [PDF]

				Y. Ohno, H. Hatabu, D. Takenaka, T. Higashino, H. Watanabe, C. Ohbayashi, M. Yoshimura, M. Satouchi, Y. Nishimura, and K. Sugimura Metastases in Mediastinal and Hilar Lymph Nodes in Patients with Non-Small Cell Lung Cancer: Quantitative and Qualitative Assessment with STIR Turbo Spin-Echo MR Imaging Radiology, June 1, 2004; 231(3): 872 - 879. [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]

				Y. Ichinose, Y. Fukuyama, H. Asoh, C. Ushijima, T. Okamoto, J. Ikeda, J. Okamoto, and M. Sakai Induction chemoradiotherapy and surgical resection for selected stage IIIB non-small-cell lung cancer Ann. Thorac. Surg., December 1, 2003; 76(6): 1810 - 1814. [Abstract] [Full Text] [PDF]

				J. H. Schouwink, L. Schultze Kool, E. J. Rutgers, F. A. N. Zoetmulder, N. van Zandwijk, M. J. v.d. Vijver, and P. Baas The value of chest computer tomography and cervical mediastinoscopy in the preoperative assessment of patients with malignant pleural mesothelioma Ann. Thorac. Surg., June 1, 2003; 75(6): 1715 - 1718. [Abstract] [Full Text] [PDF]

				J. K. LeBlanc, R. Espada, and G. Ergun Non-small Cell Lung Cancer Staging Techniques and Endoscopic Ultrasound: Tissue Is Still the Issue Chest, May 1, 2003; 123(5): 1718 - 1725. [Abstract] [Full Text] [PDF]

				D. Lardinois, A. Schallberger, D. Betticher, and H.-B. Ris Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer Ann. Thorac. Surg., April 1, 2003; 75(4): 1102 - 1106. [Abstract] [Full Text] [PDF]

				L. Kostakoglu, H. Agress Jr, and S. J. Goldsmith Clinical Role of FDG PET in Evaluation of Cancer Patients RadioGraphics, March 1, 2003; 23(2): 315 - 340. [Abstract] [Full Text] [PDF]

				E. M. Toloza, L. Harpole, and D. C. McCrory Noninvasive Staging of Non-small Cell Lung Cancer: A Review of the Current Evidence Chest, January 1, 2003; 123 (2009): 137S - 146S. [Abstract] [Full Text] [PDF]

				E. M. Toloza, L. Harpole, F. Detterbeck, and D. C. McCrory Invasive Staging of Non-small Cell Lung Cancer: A Review of the Current Evidence Chest, January 1, 2003; 123 (2009): 157S - 166S. [Abstract] [Full Text] [PDF]

				F. C. Detterbeck, M. M. DeCamp Jr., L. J. Kohman, and G. A. Silvestri Invasive Staging: The Guidelines Chest, January 1, 2003; 123 (2009): 167S - 175S. [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]

				T. F. Hany, H. C. Steinert, G. W. Goerres, A. Buck, and G. K. von Schulthess PET Diagnostic Accuracy: Improvement with In-Line PET-CT System: Initial Results Radiology, November 1, 2002; 225(2): 575 - 581. [Abstract] [Full Text] [PDF]

				H. Vesselle, J. M. Pugsley, E. Vallieres, and D. E. Wood The impact of fluorodeoxyglucose F 18 positron-emission tomography on the surgical staging of non-small cell lung cancer J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 511 - 519. [Abstract] [Full Text] [PDF]

				S. Ghamande, A. Rafanan, R. Dweik, A. C. Arroliga, and A. C. Mehta Role of Transbronchial Needle Aspiration in Patients Receiving Mechanical Ventilation* Chest, September 1, 2002; 122(3): 985 - 989. [Abstract] [Full Text] [PDF]

				J. B. Zwischenberger, C. Savage, S. K. Alpard, C. M. Anderson, S. Marroquin, and B. W. Goodacre Mediastinal Transthoracic Needle and Core Lymph Node Biopsy* : Should It Replace Mediastinoscopy? Chest, April 1, 2002; 121(4): 1165 - 1170. [Abstract] [Full Text] [PDF]

				J.F. Vansteenkiste Imaging in lung cancer: positron emission tomography scan Eur. Respir. J., February 1, 2002; 19(35_suppl): 49S - 60s. [Abstract] [Full Text] [PDF]

				C. Schaefer-Prokop and M. Prokop New imaging techniques in the treatment guidelines for lung cancer Eur. Respir. J., February 1, 2002; 19(35_suppl): 71S - 83s. [Abstract] [Full Text] [PDF]

				N. F. Esnaola, S. N. Lazarides, S. J. Mentzer, and K. M. Kuntz Outcomes and Cost-Effectiveness of Alternative Staging Strategies for Non-Small-Cell Lung Cancer J. Clin. Oncol., January 1, 2002; 20(1): 263 - 273. [Abstract] [Full Text] [PDF]

				J. Mouroux, N. Venissac, and M. Alifano Combined video-assisted mediastinoscopy and video-assisted thoracoscopy in the management of lung cancer Ann. Thorac. Surg., November 1, 2001; 72(5): 1698 - 1704. [Abstract] [Full Text] [PDF]

				J.W. A. Oosterhuis, P. H.M.H. Theunissen, and E. C.M. Bollen Improved pre-operative mediastinal staging in non-small-cell lung cancer by serial sectioning and immunohistochemical staining of lymph-node biopsies Eur. J. Cardiothorac. Surg., August 1, 2001; 20(2): 335 - 338. [Abstract] [Full Text] [PDF]

				J.F. Vansteenkiste and S.G. Stroobants The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology Eur. Respir. J., April 1, 2001; 17(4): 802 - 820. [Abstract] [Full Text] [PDF]

				M. J. Wiersema, E. Vazquez-Sequeiros, and L. M. Wiersema Evaluation of Mediastinal Lymphadenopathy with Endoscopic US-guided Fine-Needle Aspiration Biopsy Radiology, April 1, 2001; 219(1): 252 - 257. [Abstract] [Full Text]

				M. Inoue, K. Nakagawa, K. Fujiwara, K. Fukuhara, and T. Yasumitsu Results of preoperative mediastinoscopy for small cell lung cancer Ann. Thorac. Surg., November 1, 2000; 70(5): 1620 - 1623. [Abstract] [Full Text] [PDF]

				Z. T. Hammoud, R. C. Anderson, B. F. Meyers, T. J. Guthrie, C. L. Roper, J. D. Cooper, and G. A. Patterson THE CURRENT ROLE OF MEDIASTINOSCOPY IN THE EVALUATION OF THORACIC DISEASE J. Thorac. Cardiovasc. Surg., November 1, 1999; 118(5): 894 - 899. [Abstract] [Full Text] [PDF]

				B. A. Dwamena, S. S. Sonnad, J. O. Angobaldo, and R. L. Wahl Metastases from Non-Small Cell Lung Cancer: Mediastinal Staging in the 1990s-Meta-analytic Comparison Of PET and CT Radiology, November 1, 1999; 213(2): 530 - 536. [Abstract] [Full Text]

				M. Pauwels, P. Van Schil, W. De Backer, F. Van den Brande, and E. Eyskens Repeat mediastinoscopy in the staging of lung cancer Eur. J. Cardiothorac. Surg., September 1, 1999; 14(3): 271 - 273. [Abstract] [Full Text] [PDF]

				E. M. Marom, H. P. McAdams, J. J. Erasmus, P. C. Goodman, D. K. Culhane, R. E. Coleman, J. E. Herndon, and E. F. Patz Jr Staging Non-Small Cell Lung Cancer with Whole-Body PET Radiology, September 1, 1999; 212(3): 803 - 809. [Abstract] [Full Text]

				V. J Lowe and K. S Naunheim Current role of positron emission tomography in thoracic oncology Thorax, August 1, 1998; 53(8): 703 - 712. [Full Text]

				V. J. Lowe and K. S. Naunheim Positron Emission Tomography in Lung Cancer Ann. Thorac. Surg., June 1, 1998; 65(6): 1821 - 1829. [Abstract] [Full Text] [PDF]