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Japanese Journal of Clinical Oncology Feb 2006Intraoperative evaluation of mediastinal lymph nodes is a necessary step which helps us to decide whether or not to continue the operation of lung cancer. Imprint... (Comparative Study)
Comparative Study
BACKGROUND
Intraoperative evaluation of mediastinal lymph nodes is a necessary step which helps us to decide whether or not to continue the operation of lung cancer. Imprint cytology (IC) can be used as an alternative method in staging. It is a more rapid and simpler procedure than frozen section (FS) analysis. Therefore, we compared the diagnostic accuracy of IC with permanent section on 1050 mediastinal lymph nodes.
METHODS
A total of 255 non-small cell lung cancer patients who underwent surgical procedure between January 1995 and April 2004 were included. There were 236 males and 19 females with a mean age of 54.2 years (range 26-79 years). In order to obtain lymph node samples mediastinoscopy was performed in 232 (91%), anterior mediastinotomy in 50 (20%) and video-assisted thoracoscopic surgery in 16 (6.3%) patients. During final pathological diagnosis, both imprint and permanent section slides were compared.
RESULTS
There were five false-positive and eight false-negative results. The sensitivity, specificity and the predictive values for positive and negative results were 93.1, 99.5, 95.6 and 99.1%, respectively. The overall efficiency was 98.8%.
CONCLUSIONS
The diagnostic IC is an accurate, reliable, simple and less time-consuming method for evaluation of mediastinal lymph nodes in lung cancer, compared with FS method.
Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Non-Small-Cell Lung; Cytodiagnosis; False Negative Reactions; False Positive Reactions; Feasibility Studies; Female; Frozen Sections; Humans; Lung Neoplasms; Lymph Nodes; Male; Mediastinum; Middle Aged; Neoplasm Staging; Prospective Studies; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Time Factors
PubMed: 16436461
DOI: 10.1093/jjco/hyi226 -
Chest Sep 2005There is general agreement regarding the diagnostic efficacy of cervical mediastinoscopy (CMDS) and anterior mediastinotomy (AMDT) on patients with superior vena cava... (Review)
Review
STUDY OBJECTIVES
There is general agreement regarding the diagnostic efficacy of cervical mediastinoscopy (CMDS) and anterior mediastinotomy (AMDT) on patients with superior vena cava obstruction (SVCO), but controversy exists concerning the safety of these two diagnostic methods on that particular subset of patients. The purpose of the present study is to evaluate the safety and diagnostic efficacy of CMDS and AMDT in patients with SVCO.
MATERIALS AND METHODS
During the last 28 years, 39 consecutive patients with SVCO underwent biopsy of mediastinal lesions by CMDS (n = 18) or AMDT (n = 19) or both these techniques (n = 2). The medical records of all patients were reviewed, and demographic data, operative notes, perioperative complications, outcome, and histologic diagnoses were examined. The findings were compared with those of 367 patients without SVCO who underwent biopsy of mediastinal lesions during the same period of time. An up-to-date English-language literature search was performed.
RESULTS
The sensitivity of CMDS and/or AMDT in detecting malignancies in 39 patients with SVCO was 97.4%, specificity was 100%, and diagnostic accuracy was 97.4%. There was no in-hospital mortality, while morbidity consisted of five major complications and one minor complication, including two major hemorrhages and two airway obstructions. These patients, compared to those without SVCO, showed significantly higher postoperative morbidity (p < 0.001) and had a higher rate of malignancy (p < 0.001). Among 280 patients of the literature review, major hemorrhage was recorded in eight cases and airway obstruction in none.
CONCLUSIONS
CMDS and AMDT are effective methods to establish a histologic diagnosis in patients with SVCO. Although their mortality is negligible, they are accompanied by a significantly higher morbidity compared to patients without SVCO. Airway obstruction is a life-threatening complication that can occur in these patients. In our series, patients with SVCO had a higher rate of malignancy compared to patients without SVCO.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Mediastinal Diseases; Mediastinal Neoplasms; Mediastinoscopy; Mediastinum; Middle Aged; Neck; Sensitivity and Specificity; Sternum; Superior Vena Cava Syndrome; Thoracotomy; Treatment Outcome
PubMed: 16162757
DOI: 10.1378/chest.128.3.1551 -
European Journal of Cardio-thoracic... May 2005Mediastinal lymph node biopsy plays a fundamental role in diagnosis, staging and management of lung cancer. We describe a novel method of using the video-mediastinoscope...
Mediastinal lymph node biopsy plays a fundamental role in diagnosis, staging and management of lung cancer. We describe a novel method of using the video-mediastinoscope for concurrent cervical mediastinotomy and anterior mediastinoscopy. We have performed five concurrent procedures using this system in the last 14 months. In four cases, we assessed the aorto-pulmonary (A-P) window lymph nodes. In the fifth case, we performed a cervical mediastinoscopy for para-tracheal and sub-carinal lymphadenopathy followed by an anterior videomediastinotomy, video assisted intrapericardial assessment, direct tumour sampling and A-P window lymph nodal biopsies. Due to the excellent visualisation afforded by the Videomediastinoscope, we were able to avoid an open procedure in all cases. We believe that this represents a major benefit of the videomediastinoscope in select cases.
Topics: Aged; Biopsy; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinoscopy; Neoplasm Staging
PubMed: 15848339
DOI: 10.1016/j.ejcts.2005.01.052 -
World Journal of Surgery Apr 2005Deep inframanubrial parathyroid tumors have traditionally been excised through a median sternotomy. With the advent of minimally invasive surgical access, we chose to...
Deep inframanubrial parathyroid tumors have traditionally been excised through a median sternotomy. With the advent of minimally invasive surgical access, we chose to examine the treatment options and outcomes of patients with inframanubrial mediastinal parathyroid tumors. Patients with primary hyperparathyroidism seen at a university medical center over a 12-year period were retrospectively reviewed. The utility of localization studies, methods of treatment, complications, and outcomes were examined in patients with a parathyroid tumor located in the mediastinum inferior to the manubrium. Patients with parathyroid adenomas located at the thoracic inlet were excluded. Sixteen patients with inframanubrial mediastinal tumors were treated during the study period. Altogether, 81% of the patients had undergone at least one prior neck exploration for primary hyperparathyroidism. Preoperative calcium and parathyroid hormone levels were 12.4 +/- 0.36 mg/dl and 273 +/- 70 pg/ml, respectively. Localization studies identified mediastinal parathyroid adenomas in the following locations: anterior mediastinum (n = 8), middle mediastinum (n = 7), posterior mediastinum (n = 1). Mediastinal computed tomography and technetium-sestamibi scans demonstrated the best sensitivity, 92% and 85%, respectively. Seven patients underwent successful excision of the mediastinal adenoma by transcervical mediastinal exploration with the Cooper retractor. The other patients underwent angiographic ablation (n = 4), anterior mediastinotomy (n = 3), video-assisted thoracoscopy (VATS) (n = 1), and VATS plus thoracotomy (n = 1). The mean hospital stay for the study group was 2.9 +/- 0.7 days. The complication rate was 25%. All patients were normocalcemic after a mean follow-up of 15 +/- 7 months. Most inframanubrial mediastinal parathyroid tumors can be successfully managed without median sternotomy.
Topics: Adenoma; Adolescent; Adult; Aged; Calcium; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Male; Mediastinum; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Hormone; Parathyroid Neoplasms; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sternum; Technetium Tc 99m Sestamibi; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed
PubMed: 15770373
DOI: 10.1007/s00268-004-7731-7 -
Archivos de Bronconeumologia Mar 2005To study the specific importance of mediastinal staging in women with nonsmall cell lung cancer. (Comparative Study)
Comparative Study
OBJECTIVE
To study the specific importance of mediastinal staging in women with nonsmall cell lung cancer.
PATIENTS AND METHODS
Between July 1981 and September 2003 we surgically staged 2172 patients with nonsmall cell lung cancer who met the inclusion criteria for resectability and operability. A subgroup of 108 women was studied. Cervical mediastinoscopy was performed in all cases, with the addition of anterior mediastinotomy in cases with left upper lobe involvement. All patients underwent a preoperative computed tomography chest scan.
RESULTS
Cervical mediastinoscopy was performed on all 108 patients, 26 of whom also underwent anterior mediastinotomy. Positive findings were recorded in 44 (40.7%) of the 108 cases: 39 of the 108 mediastinoscopies (36.1%), 9 of the 26 mediastinotomies (34.6%), and in 5 cases (19.2%) both mediastinoscopy and mediastinotomy. Nodal involvement was found in 13% of cases in clinical stage IA and 30.8% of cases in clinical stage IB. The percentage of positive findings was significantly higher for cases with adenocarcinoma or large cell carcinoma (P<.05). We performed 67 thoracotomies: 46 patients underwent lobectomy (42.6% of the 108), 7 bilobectomy (6.5%), 9 pneumonectomy (8.3%), and 5 exploratory thoracotomy (4.6%). The agreement between clinical staging after mediastinoscopy and pathological staging after thoracotomy was 47% (stage IA) and 57% (stage IB).
CONCLUSIONS
Routine mediastinoscopy is indicated for all women with nonsmall cell lung cancer, regardless of clinical stage.
Topics: Adenocarcinoma; Carcinoma, Large Cell; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Chi-Square Distribution; Data Interpretation, Statistical; Female; Humans; Lung Neoplasms; Mediastinoscopy; Neoplasm Staging; Pneumonectomy; Radiography, Thoracic; Sex Factors; Thoracotomy; Tomography, X-Ray Computed
PubMed: 15766464
DOI: 10.1016/s1579-2129(06)60412-6 -
International Journal of Obstetric... Jan 2002A parturient at 35 weeks' gestation presented with severe shortness of breath, orthopnea and signs of fetal compromise. She was diagnosed with a large mediastinal tumour...
A parturient at 35 weeks' gestation presented with severe shortness of breath, orthopnea and signs of fetal compromise. She was diagnosed with a large mediastinal tumour occupying 65% of transthoracic diameter, and a pericardial effusion. The trachea, both mainstem bronchi, pulmonary artery and superior vena cava were compressed. Her dyspnea continued despite relief of the cardiac tamponade by percutaneous drainage. Tissue obtained via anterior mediastinotomy, performed under local anesthesia infiltration, revealed a definitive diagnosis of non-Hodgkin's lymphoma. The patient improved symptomatically following initiation of steroids and chemotherapy. She was delivered by elective cesarean section under epidural anesthesia on the fifth day after starting chemotherapy. The postoperative course was complicated by the development of a large pleural effusion that required drainage. Mother and baby were well at three and six-month follow up oncology visits.
PubMed: 15321577
DOI: 10.1054/ijoa.2001.0915 -
The Journal of Thoracic and... Aug 2004Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical...
OBJECTIVE
Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program.
METHODS
From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed.
RESULTS
Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1%), and lung cancer was found in 45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27% of patients. Operative mortality was 1.7%.
CONCLUSION
Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5% of the pulmonary nodules identified.
Topics: Aged; Aged, 80 and over; Female; Humans; Lung Diseases; Lung Neoplasms; Male; Mass Screening; Middle Aged; Thoracic Surgical Procedures; Tomography, X-Ray Computed
PubMed: 15282462
DOI: 10.1016/j.jtcvs.2004.02.017 -
African Journal of Medicine and Medical... Dec 2001This is a review of our experience with anterior mediastinotomy (AM) in the diagnosis and evaluation of diseases of the mediastinum and lung. Thirty consecutive patients...
This is a review of our experience with anterior mediastinotomy (AM) in the diagnosis and evaluation of diseases of the mediastinum and lung. Thirty consecutive patients who had AM between 1984 and 1999 were retrospectively studied. The mean age of patients was 28 +/- 6.5 years. There were 22 males to 8 females. Sixteen patients had superior vena cava (SVC) obstruction (12 patients with lung cancer, 4 with primary mediastinal tumours), 4 patients had radiological evidence of mediastinal contiguity of upper lobe tumours and 10 patients had primary mediastinal tumours. AM was 1st procedure in 10 patients and 2nd procedure in 20 patients after failed or inconclusive result from FNAB, scalene node/cervical lymph node biopsy or bronchoscopy. Eighteen right-sided and 12 left-sided AMs were performed. Satisfactory histological diagnoses were achieved in all patients. Complications were easily controlled bleeding (4 patients) and life-threatening haemorrhage in 2 patients. Three patients had delayed wound healing and 4 had inadvertent pleural entries. There was no mortality temporarily related to the procedure. We conclude that AM is valuable as a surgical technique for obtaining tissue for histological purposes in diseases of the mediastinum and the lung when tissue specimens from less invasive procedures are unsatisfactory.
Topics: Adult; Blood Loss, Surgical; Female; Humans; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinoscopy; Pleura; Retrospective Studies; Superior Vena Cava Syndrome; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 14510116
DOI: No ID Found -
The Annals of Thoracic Surgery Sep 2003The diagnostic and staging value of cervical mediastinoscopy is well established. Left anterior mediastinotomy is of further value in assessing left upper lobe tumors....
BACKGROUND
The diagnostic and staging value of cervical mediastinoscopy is well established. Left anterior mediastinotomy is of further value in assessing left upper lobe tumors. However the efficacy and safety of both these procedures after median sternotomy for cardiac surgery is unknown.
METHODS
We undertook a retrospective review of our experience of mediastinal exploration by cervical mediastinoscopy with or without left anterior mediastinotomy in patients with prior sternotomy between 1980 and 2001.
RESULTS
During this period 28 patients (25 male and 3 female; mean age, 63 +/- 10 years), all with prior sternotomy for cardiac surgery (14 had left internal mammary artery graft), underwent mediastinal exploration. The mean interval between sternotomy and mediastinal exploration was 7.2 +/- 5.1 years. Additionally, 3 patients also had superior vena cava obstruction. Cervical mediastinoscopy was performed in all 28 patients and additionally left anterior mediastinotomy was undertaken in 7 of 28 patients (4 with left internal mammary artery graft). Indications for exploration were staging of lung cancer in 22 patients (cervical mediastinoscopy, n = 22; left anterior mediastinotomy, n = 7) and diagnostic biopsy of mediastinal mass in 6 patients (cervical mediastinoscopy, n = 6). Thorough mediastinal assessment was possible in all 28 patients. In the 22 patients with lung cancer the median number of lymph node stations sampled during mediastinoscopy was 3 (range, 1 to 5). A specific diagnosis was obtained in 16 patients (metastatic lung cancer, n = 10; lymphoma, n = 3; sarcoidosis, sinus histiocytosis, and metastatic melanoma, n = 1 each). The other 12 patients with negative findings underwent pulmonary resection and only 1 of 12 (8%) patients had unexpected N2 disease, a similar proportion to our overall experience with lung cancer. There were no operative complications.
CONCLUSIONS
Prior sternotomy for cardiac surgery does not compromise the efficacy and the safety of mediastinoscopy and mediastinotomy.
Topics: Adult; Aged; Cardiac Surgical Procedures; Female; Humans; Male; Mediastinoscopy; Mediastinum; Middle Aged; Postoperative Care; Retrospective Studies; Risk Factors; Sternum
PubMed: 12963219
DOI: 10.1016/s0003-4975(03)00512-5 -
Archivos de Bronconeumologia Jan 2003To validate our experience with standard cervical mediastinoscopy (SCM) and extended cervical mediastinoscopy (ECM) to diagnose mediastinal nodes and masses, we studied...
To validate our experience with standard cervical mediastinoscopy (SCM) and extended cervical mediastinoscopy (ECM) to diagnose mediastinal nodes and masses, we studied 181 patients between January 1992 and February 2001. SCM and ECM were indicated for diagnostic staging of nodes related to bronchogenic carcinoma (Group I) or of mediastinal masses (Group II). An SCM was performed in all cases to explore the paratracheal region (2R, 2L, 4R, 4L, 7, 10R and 10L); in 21 additional cases, an ECM was performed to explore the aortopulmonary window or the subaortic region (area 5) and the para-aortic region (area 6). In Group I, the sensitivity of SCM was 93.6% and specificity was 100%; the positive predictive value (PPV) was 100%, the negative predictive value (NPV) was 82.8%, and the diagnostic yield was 95.1%. The sensitivity of ECM was 91% and specificity was 100%; PPV was 100%, NPV 93.3% and yield was 96%. In Group II, the sensitivity was 93.3%, specificity 100%, PPV 100%, NPV 81.2% and diagnostic yield 94.8%. The sensitivity of ECM in this group was 80%, specificity was 100%, PPV 100%, NPV 66.7% and yield 85.7%. A 2.7% complication rate was observed, with one case of bleeding after injury to the superior vena cava, one tracheal lesion, one recurring paralysis and two cases of surgical wound infection. The mean postoperative stay was 36 hours and mortality was zero. We conclude that SCM is highly specific for the evaluation of mediastinal node involvement in bronchogenic carcinoma and it is the approach of choice when a diagnosis of lesions located in the mid-mediastinal region has not been reached. ECM is a valid, safe alternative to anterior mediastinotomy for staging nodes and masses occupying para-aortic zones or the aortopulmonary window, with good diagnostic yield, low morbidity and absence of mortality.
Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Bronchogenic; Carcinoma, Large Cell; Carcinoma, Small Cell; False Negative Reactions; False Positive Reactions; Female; Hodgkin Disease; Humans; Male; Mediastinal Neoplasms; Mediastinoscopy; Middle Aged; Predictive Value of Tests; Proteins; Retrospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed
PubMed: 12550017
DOI: 10.1016/s0300-2896(03)75311-3