THORACOSCOPIC STAGING OF IIIB NONSMALL CELL LUNG-CANCER BEFORE NEOADJUVANT THERAPY

Background. Bronchoscopy and imaging, techniques are the most valuable tools for noninvasive staging of patients with locally advanced non-s mall cell lung cancer but their overall accuracy is not satisfactory. Neoadjuvant therapy protocols require strict criteria for patient sele ction and invasive staging should be carried out to establish standard ized inclusion criteria and to homogenize posttreatment results. The a im of this prospective study was to evaluate the role of thoracoscopy in the assessment of the real extent of lung cancer in patients with t he clinical suspicion of stage IIIB disease. Methods. From January 199 3 to March 1996, we observed 64 patients with suspected IIIB non-small cell lung cancer. Forty-three patients were considered eligible for t his study and were divided into three groups: group I, cytologically n egative pleural effusion (n = 10); group II, computed tomographic susp icion of mediastinal infiltration (n = 30); and group III, contralater al lymphadenopathy not accessible by mediastinoscopy (n = 3). Results. No complications related to thoracoscopy occurred. Of 10 patients in group I, thoracoscopy up-staged the disease to IIIB in 6 (60%). Of 30 patients with suspicion of T4 (group II), thoracoscopy confirmed T4 in 15 patients (50%). Nine (30%) were downstaged to stage IIIA and 2 (6. 6%) to stage II. In 4 patients (13.4%) thoracoscopy failed to yield de finitive staging. In all 3 patients of group III, thoracoscopy confirm ed stage IIIB. Conclusions. Thoracoscopy proved adequate for correct s taging in 39 of 43 patients (91%); therefore, it should be considered in tile staging work-up of suspected stage IIIB patients.