Does Video-Assisted Mediastinoscopy Offer Lower False-Negative Rates for Subcarinal Lymph Nodes Compared with Standard Cervical Mediastinoscopy?
09 July 2013
26 September 2013
02 December 2013 (online)
Objectives Theoretically, video-assisted mediastinoscopy (VAM) offers improved staging of subcarinal lymph nodes (LNs) compared with standard cervical mediastinoscopy (SCM).
Materials and Methods Between 2006 and 2011, 553 patients (SCM, n = 293; VAM, n = 260) with non–small cell lung carcinoma who underwent mediastinoscopy were investigated. Mediastinoscopy was performed only in select patients based on computed tomography (CT) or positron emission tomography CT scans in our center.
Results The mean number of LNs and stations sampled per case was significantly higher with VAM (n = 7.65 ± 1.68 and n = 4.22 ± 0.83) than with SCM (n = 6.91 ± 1.65 and 3.92 ± 86.4; p < 0.001). The percentage of patients sampled in station 7 was significantly higher with VAM (98.8%) than with SCM (93.8%; p = 0.002). Mediastinal LN metastasis was observed in 114 patients by mediastinoscopy. The remaining 439 patients (203 patients in VAM and 236 in SCM) underwent thoracotomy and systematic mediastinal lymphadenectomy (SML). SML showed mediastinal nodal disease in 23 patients (false-negative [FN] rate, 5.2%). The FN rate was higher with SCM (n = 14, 5.9%) than with VAM (n = 9, 4.4%), although this difference was not statistically significant (p = 0.490). Station 7 was the most predominant station for FN results (n = 15). The FN rate of station 7 was found to be higher with SCM (n = 9, 3.8%) than with the VAM group (n = 6, 2.9%; p = 0.623).
Conclusion FN were more common in mediastinoscopy of subcarinal LNs. VAM allows higher rates of sampling of mediastinal LN stations and station 7, although it did not improve staging of subcarinal LNs.
Presented at the Young Investigators Forum Session of the 20th European Conference on General Thoracic Surgery, Essen, Germany, June 10–13, 2012.
- 1 Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: what is the significant node that affects survival?. J Thorac Cardiovasc Surg 1999; 118 (2) 270-275
- 2 Uehara H, Sakao Y, Mun M , et al. Prognostic value and significance of subcarinal and superior mediastinal lymph node metastasis in lower lobe tumours. Eur J Cardiothorac Surg 2010; 38 (4) 498-502
- 3 Lemaire A, Nikolic I, Petersen T , et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 2006; 82 (4) 1185-1189 , discussion 1189–1190
- 4 Hammoud ZT, Anderson RC, Meyers BF , et al. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg 1999; 118 (5) 894-899
- 5 Anraku M, Miyata R, Compeau C, Shargall Y. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?. Ann Thorac Surg 2010; 89 (5) 1577-1581
- 6 Cerfolio RJ, Bryant AS, Ojha B, Eloubeidi M. Improving the inaccuracies of clinical staging of patients with NSCLC: a prospective trial. Ann Thorac Surg 2005; 80 (4) 1207-1213 , discussion 1213–1214
- 7 Sortini A, Navarra G, Santini M , et al. Mediastinoscopia videoassistita. Nuova applicazione della technologia televisiva in chirurgia [Video-assisted mediastinoscopy. A new application of television technology in surgery]. Minerva Chir 1994; 49 (9) 803-805 [in Italian]
- 8 Hürtgen M, Friedel G, Toomes H, Fritz P. Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA)—technique and first results. Eur J Cardiothorac Surg 2002; 21 (2) 348-351
- 9 Sayar A, Citak N, Metin M , et al. Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer. Gen Thorac Cardiovasc Surg 2011; 59 (12) 793-798
- 10 De Leyn P, Lardinois D, Van Schil PE , et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg 2007; 32 (1) 1-8
- 11 Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA ; American College of Chest Physicians. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (3, Suppl): 202S-220S
- 12 Nelson E, Pape C, Jørgensen OD, Olsen KE, Licht PB. Mediastinal staging for lung cancer: the influence of biopsy volume. Eur J Cardiothorac Surg 2010; 37 (1) 26-29
- 13 Venissac N, Alifano M, Mouroux J. Video-assisted mediastinoscopy: experience from 240 consecutive cases. Ann Thorac Surg 2003; 76 (1) 208-212
- 14 Witte B, Hürtgen M. Video-assisted mediastinoscopic lymphadenectomy (VAMLA). J Thorac Oncol 2007; 2 (4) 367-369
- 15 Leschber G, Sperling D, Klemm W, Merk J. Does video-mediastinoscopy improve the results of conventional mediastinoscopy?. Eur J Cardiothorac Surg 2008; 33 (2) 289-293
- 16 Metin M, Citak N, Sayar A , et al. The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures?. J Thorac Oncol 2011; 6 (10) 1713-1719
- 17 Obiols C, Call S, Rami-Porta R , et al. Extended cervical mediastinoscopy: mature results of a clinical protocol for staging bronchogenic carcinoma of the left lung. Eur J Cardiothorac Surg 2012; 41 (5) 1043-1046
- 18 Sayar A, Citak N, Büyükkale S , et al. Impact of extended cervical mediastinoscopy in staging of left lung carcinoma. Thoracic Cancer 2013; 4 (4) 361-368
- 19 Walles T, Friedel G, Stegherr T, Steger V. Learning mediastinoscopy: the need for education, experience and modern techniques–interdependency of the applied technique and surgeon's training level. Interact Cardiovasc Thorac Surg 2013; 16 (4) 450-454
- 20 Lardinois D, Schallberger A, Betticher D, Ris HB. Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer. Ann Thorac Surg 2003; 75 (4) 1102-1106