Videomediastinoscopy: a ten year experience on lung cancer stadiation and non-diagnosed mediastinal lymphoadenopathy.

Cervical Mediastinoscopy (CM) is a surgical procedure in it's own right requiring an operating room and general anesthesia and, in the recent past, the absence of minimally invasive techniques had created the myth of mediastinoscopy as the "gold standard" for the pathological staging of the mediastinum. Nowadays, investigating the mediastinum is different and this calls for a review of the role of the "gold standard" CM. Between January 1999 and December 2012 a total of 303 CM were performed; 167 for pre-operative lung cancer stadiation and 136 for non-diagnosed enlargement of mediastinal nodes. The nodal stations investigated where those usually obtainable with CM. Out of 167 CM for lung cancer stadiation, 102 were positive for metastatic nodal disease, 65 were negative. Out of 136 VAMs performed for other reason (indications other than lung cancer) 15 were diagnostic for lymphoma (NLH LH 2 4), 8 revealed non metastatic lung disease, 55 were suggestive for sarcoidosis, 10 for tubercular adenitis and 48 for non-specific adenitis. The data presented in this paper refer to the activity of a single institution in the period between 1999 and 2012 and the results we have extrapolated correspond with our idea that, despite the progress of new methods, we cannot as yet, do without mediastinoscopy.

Differential diagnosis and management of focal ground-glass opacities.

Focal pulmonary ground-glass opacities (GGOs) can be associated with bronchioloalveolar carcinoma. The present retrospective study aimed to test the validity of a multistep approach to discriminate malignant from benign localised (focal) GGOs, identifies useful diagnostic features on computed tomography (CT), and suggests appropriate management guidelines. A stepwise approach, including oral antibiotics, follow-up high-resolution CT (HRCT) 40-60 days later and CT-guided core biopsy, was used. All cases with localised GGOs detected since 2001 were reviewed. CT features were described according to a structured scheme. In total, 40 patients were evaluated. Of these, 11 patients were diagnosed with benign GGOs, 19 patients had lung cancer and 10 were undetermined. Nonpolygonal shape, apparent radial growth and clear-cut margins were associated with a malignant histology. The specificity of CT findings was low. Diagnostic accuracy increased after oral antibiotics, follow-up HRCT and percutaneous core biopsy. Overall, 18 patients underwent surgery for lung cancer. In conclusion, malignant ground-glass opacities have a fairly typical appearance, but some benign lesions closely mimic their malignant counterparts. The stepwise approach adopted in the present study increased the diagnostic specificity and reduced time to definitive diagnosis. Segmentectomy might be the ideal resection volume for such tumours.