MEDIASTINAL STAGING OF LUNG-CANCER - IS MEDIASTINOSCOPY STILL ESSENTIAL

The significance of computed tomography of the thorax and mediastinosc opy in pretherapeutic mediastinal assessment for the staging of lung c ancer remains controversial. The present study was designed to establi sh a standard approach to cervical mediastinoscopy for otolaryngologis ts, who in Denmark traditionally are involved in the staging of non-sm all cell lung cancer. Sixty-four potentially operable patients with no n-small cell lung cancer underwent thoracic computed tomography prior to bronchoscopy and cervical mediastinoscopy. Thirty-six of the 43 med iastinoscopically negative patients additionally underwent thoracotomy , which in 32 cases was considered curative. Mediastinoscopy alone est ablished the lung cancer diagnosis in 20% of the patients. In diagnosi ng lymph node metastases in the superior mediastinum, a criterion of 1 0 mm for abnormal enlargement resulted in an overall sensitivity and s pecificity of mediastinal computed tomography of 72% and 85%, respecti vely, and the overall false-negative and false-positive rates appeared to be 18% and 25%, respectively. No clinicopathological characteristi cs could be identified that influenced the occurrence of mediastinal m etastases or the accuracy of computed tomography. It is concluded that mediastinoscopy remains essential in the evaluation of patients with presumed or verified non-small cell lung cancer. For otolarngologists, the strategy of routine cervical mediastinoscopy, performed under gen eral anaesthesia in the same procedure as bronchoscopy, is advocated a s a standard approach to preoperative mediastinal assessment for the s taging of non-small cell lung cancer.