Should all candidates with operable non-small cell pulmonary malignancy undergo cervical mediastinoscopy preoperatively?

Background

Mediastinoscopy is the procedure of choice for the assesment of mediastinal lymph node (MLN) metastatic disease. Cervical mediastinoscopy allows exploration of lymph nodes in the paratracheal and pretracheal regions, in the tracheobronchial angles, and in the anterior aspect of the subcarinal space. So we aimed to investigate the role of mediastinoscopy in the diagnosis of MLN involvement in patients with non small cell lung cancer.

Methods

This study is a cross-sectional, randomized study. Inclusion criteria included patients with potentially operable bronchogenic carcinoma who showed no evidence of MLN involvement using the CT scan. PET scan was added as an investigative tool as a routine in all patients with lung cancer.Exclusion criteria included patients who were preoperatively known to have small cell lung cancer, and patients with negative MLN affection (N0/N1) by the FDG- PET. Cervical mediastinoscopy was done to all included patients.

Results

34 patients were full filling our inclusion criteria for mediastinoscopy.

31 Patients proved to have MLN metastasis by mediastinoscopy, and were referred back to the chest oncologist for neo-adjuvant chemo or radiotherapy.

3 patients, were negative on mediastinoscopy underwent surgery for resection. Their post operative MLN sampling had shown that they had no MLN metastasis. Their pathology results had shown that, two of them had adenocarcinoma and one squamous cell carcinoma.

Conclusions

Patients with operable NSCLC with negative mediastinal CT scan, should perform PET scan and mediastinoscopy if they are highly suspicious of having occult N2 disease to prevent an unnecessary thoracotomy.