Elsevier

The Annals of Thoracic Surgery

Volume 64, Issue 5, November 1997, Pages 1409-1411
The Annals of Thoracic Surgery

Thoracoscopic Staging of IIIB Non–Small Cell Lung Cancer Before Neoadjuvant Therapy

https://doi.org/10.1016/S0003-4975(97)00764-9Get rights and content

Background

Bronchoscopy and imaging techniques are the most valuable tools for noninvasive staging of patients with locally advanced non–small cell lung cancer but their overall accuracy is not satisfactory. Neoadjuvant therapy protocols require strict criteria for patient selection and invasive staging should be carried out to establish standardized inclusion criteria and to homogenize posttreatment results. The aim of this prospective study was to evaluate the role of thoracoscopy in the assessment of the real extent of lung cancer in patients with the clinical suspicion of stage IIIB disease.

Methods

From January 1993 to March 1996, we observed 64 patients with suspected IIIB non–small cell lung cancer. Forty-three patients were considered eligible for this study and were divided into three groups: group I, cytologically negative pleural effusion (n = 10); group II, computed tomographic suspicion of mediastinal infiltration (n = 30); and group III, contralateral lymphadenopathy not accessible by mediastinoscopy (n = 3).

Results

No complications related to thoracoscopy occurred. Of 10 patients in group I, thoracoscopy up-staged the disease to IIIB in 6 (60%). Of 30 patients with suspicion of T4 (group II), thoracoscopy confirmed T4 in 15 patients (50%). Nine (30%) were downstaged to stage IIIA and 2 (6.6%) to stage II. In 4 patients (13.4%) thoracoscopy failed to yield definitive staging. In all 3 patients of group III, thoracoscopy confirmed stage IIIB.

Conclusions

Thoracoscopy proved adequate for correct staging in 39 of 43 patients (91%); therefore, it should be considered in the staging work-up of suspected stage IIIB patients.

Section snippets

Material and Methods

From January 1993 to March 1996, 64 patients with suspected IIIB non–small cell lung cancer were seen at our department. Clinical staging was accomplished by fiberoptic bronchoscopy, total body computed tomography, bone scan, and magnetic resonance imaging in selected patients. Five patients with vocal cord paralysis, 4 with cancer extension in the trachea demonstrated by fiberoptic bronchoscopy, 2 with superior vena cava syndrome, and 10 with malignant pleural effusion with positive cytology

Results

No complications related to VAT occurred (Table 1). The chest tube was removed 24 to 36 hours after the operation and all VAT patients were discharged from hospital on the first or second postoperative day. In 10 patients in group I, frozen sections showed malignant pleural involvement in 6 patients. Therefore, these patients were referred for chemotherapy and radiation therapy. In the remaining 4 patients, pleural biopsies were negative for cancer infiltration and VAT was converted to

Comment

Neoadjuvant therapy has become a well-accepted approach for stage IIIA non–small cell lung cancer. Its efficacy is being evaluated for stage IIIB, which is usually considered to be locally advanced lung cancer, incurable, and not surgically treated. However, it is often difficult to assess and compare the outcome of stage IIIB patients if they are only clinically staged. In fact, the lack of histologic confirmation of the real extent of the tumor makes it difficult to distinguish which patients

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