Open AccessImpact of extended cervical mediastinoscopy in staging of left lung carcinoma
Author(s) -
Sayar Adnan,
Çitak Necati,
Büyükkale Songül,
Metin Muzaffer,
Kök Abdulaziz,
Yurt Sibel,
Çelikten Alper,
Gürses Atilla
Publication year - 2013
Publication title -
thoracic cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 28
eISSN - 1759-7714
pISSN - 1759-7706
DOI - 10.1111/1759-7714.12026
Subject(s) - medicine , mediastinoscopy , cervical carcinoma , left lung , radiology , lung , carcinoma , oncology , lung cancer , cervical cancer , cancer
Abstract Background Extended cervical mediastinoscopy ( ECM ) is a method for staging lung carcinoma. We aimed to demonstrate the impact of ECM in the staging of lung carcinoma. Methods Between 1998 and 2011, 159 patients with left lung carcinoma who underwent ECM simultaneously with standard cervical mediastinoscopy ( SCM ), were retrospectively analyzed. Until 2006, ECM had been performed routinely ( n = 90, routine ECM ), however, after 2006 ECM was performed only in patients selected based on computed tomography and positron emission tomography scans ( n = 69, selective ECM ). Results Mediastinal lymph node metastasis was present in 36 patients by mediastinoscopy. Aortopulmonary window ( APW ) lymph node metastasis was present in 26 patients (10 in the routine group, 16 in the selective group), whereas the 10 patients who had mediastinal lymph node metastasis that could only be accessed by SCM, but had no APW lymph node metastasis, were excluded. The remaining 123 patients (72 in the routine group, 51 in the selective group) were identified as cN0/N1 by SCM / ECM , and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 64, 43, and 16 of these patients, respectively. According to the lymphadenectomy, APW lymph node metastasis was determined in 11 patients (seven in the routine group, four in the selective group). Sensitivity, negative predictive value ( NPV ), and accuracy of ECM were calculated as 0.70, 0.90, and 0.92, respectively. Staging values of routine/selective ECM protocols were 0.58/0.80, 0.89/0.91 and 0.91/0.94, respectively. The complication rate was 5% ( n = 8). Conclusions ECM has an adequate NPV and accuracy in determining metastasis to the APW lymph nodes in patients with left lung carcinoma.