RESUMO
A quarter of patients with clinical N1 (cN1) non-small cell lung cancer (NSCLC) based on positron emission tomography-computed tomography (PET-CT) imaging have occult mediastinal nodal involvement (N2 disease). In a prospective study, endosonography alone had an unsatisfactory sensitivity (38%) in detecting N2 disease. The current prospective multicentre trial investigated the sensitivity of preoperative mediastinal staging by video-assisted mediastinoscopy (VAM) or VAM-lymphadenectomy (VAMLA).Consecutive patients with operable and resectable (suspected) NSCLC and cN1 after PET-CT imaging underwent VAM(LA). The primary study outcome was sensitivity to detect N2 disease. Secondary endpoints were the prevalence of N2 disease, negative predictive value (NPV) and accuracy of VAM(LA).Out of 105 patients with cN1 on imaging, 26% eventually developed N2 disease. Invasive mediastinal staging with VAM(LA) had a sensitivity of 73% to detect N2 disease. The NPV was 92% and accuracy 93%. Median number of assessed lymph node stations during VAM(LA) was 4 (IQR 3-5), and in 96%, at least three stations were assessed.VAM(LA) has a satisfactory sensitivity of 73% to detect mediastinal nodal disease in cN1 lung cancer, and could be the technique of choice for pre-resection mediastinal lymph node assessment in this patient group with a one in four chance of occult-positive mediastinal nodes after negative PET-CT.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Endossonografia , Neoplasias Pulmonares/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Mediastinoscopia , Estadiamento de Neoplasias/métodos , Idoso , Bélgica , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Prospectivos , Cirurgia VídeoassistidaRESUMO
We report the case of a patient with suspected hamartoma with slight fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET). Initially, follow-up with repeat computed tomography (CT) scan was proposed. Because of the risk for retro-obstructive pneumonia, and because there was a small increase in diameter of the lesion on CT, thoracotomy was proposed. Pathologic examination revealed a surprising and rare finding.
Assuntos
Neoplasias Brônquicas/diagnóstico por imagem , Tumor Carcinoide/diagnóstico por imagem , Hamartoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Segunda Neoplasia Primária/diagnóstico por imagem , Ossificação Heterotópica/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Brônquicas/cirurgia , Tumor Carcinoide/cirurgia , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Hamartoma/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Metaplasia/patologia , Pessoa de Meia-Idade , Ossificação Heterotópica/patologia , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios XRESUMO
Involvement of mediastinal nodes has a dramatic prognostic and therapeutic impact in patients with non-small cell lung cancer. Cervical mediastinoscopy remains the most important technique for staging of the mediastinum. The technique of extended mediastinoscopy and redo mediastinoscopy are described as well. Indications, technique and complications are discussed.