MEDIASTINAL STAGING OF NON-SMALL-CELL LUNG-CANCER - COMPUTED-TOMOGRAPHY AND CERVICAL MEDIASTINOSCOPY

The exact indications for computed tomography (CT) of the thorax and m ediastinoscopy (MS) in lung cancer still remain incompletely defined. The present study was designed to establish a standard approach to cer vical MS for otolaryngologists, who in Denmark are traditionally invol ved in the staging of non-small-cell lung cancer (NSCLC). Sixty-four p otentially operable patients with NSCLC underwent thoracic CT prior to bronchoscopy and cervical MS. Cervical MS alone established the histo logical diagnosis in 20% of the patients. In diagnosing lymph node met astases in the superior mediastinum, a criterion of 10 mm for abnormal enlargement resulted in an overall sensitivity and specificity of med iastinal CT of 81 and 84%, respectively, and the overall false-negativ e and false-positive rates appeared to be 10 and 29%, respectively. It could be demonstrated that mediastinal lymph nodes in patients with m ediastinal metastases were significantly larger than mediastinal lymph nodes in patients without metastases. No clinicopathological characte ristics could be identified to influence the accuracy of CT, except fo r the finding that the rate of false-negative mediastinal CT was signi ficantly higher in patients with right-sided than in patients with lef t-sided lesions. It is concluded that because of the relatively low se nsitivity and specificity of mediastinal CT, cervical MS remains essen tial in the evaluation of patients with presumed or verified NSCLC and that cervical MS, in experienced hands, is a safe and accurate proced ure. For Danish otolaryngologists, the strategy of routine cervical MS , performed under general anaesthesia in the same stage as bronchoscop y, is advocated as a standard approach to mediastinal assessment for t he staging of NSCLC. However, thoraco-abdominal CT is advocated for al l patients with NSCLC, in whom operation is contemplated, as a supplem entary investigation after other routine diagnostic and staging proced ures, including cervical MS, have been carried out.