PURPOSE: Invasive mediastinal staging is proposed for the central located resectable non- small cell lung cancer (NSCLC) before thoracotomy according to European Society of Thoracic Surgery (ESTS) guidelines. In this study we aimed to analyze the importance and necessity of mediastinoscopy and the efficacy of Positron Emission Tomography- computerized tomography (PET-CT) for mediastinal staging in NSCLC.
METHODS: Between years 2005 and 2008, there were 347 patients with resectable NSCLC in our hospital. All patients had thorax CT before surgery. Localization of the tumors were defined by using CT and Fiberoptic Bronchoscopy (FOB). Tumors are categorized as central or peripherial. Positron Emission Tomography (PET) - CT was performed in 231 patients. Patients with histologically proven mediastinal nodal tumor involvement were received induction chemotherapy. Other patients underwent thoracotomy and lung resection including the mediastinal lymph node dissection. Mediastinal lymph node involvement was analyzed in patients with centrally located or peripheral tumors.. We also analyzed the efficacy of mediastinoscopy and other diagnostic procedures (CT or PET/CT) in mediastinal lymph node involvement. Mediastinoscopic (in N2 patients) and/or final resectional pathology was taken as final modlity for lymph node involvement.
RESULTS: Tumors were central in 127(37%) and peripheral in 220 (63%) patients. In 33% of patients with central tumors had mediastinal metastatic disease, whereas the rate was 24% in patients with peripheral tumor (p=0.04).
CONCLUSION: Central NSCLC have a higher rate of mediastinal lymph node metastasis than that of peripheral tumors. The accuracy rate of imaging methods for staging was decreased in patients with central tumours. Mediastinoscopy has a distinctly higher accuracy rate for mediastinal staging.
CLINICAL IMPLICATIONS: According to results of our study group mediastinoscopy should routinely performed in centrally located NSCLC for appropriate mediastinal staging.
DISCLOSURE: Akif Turna, No Financial Disclosure Information; No Product/Research Disclosure Information