ROLE OF CERVICAL MEDIASTINOSCOPY IN STAGING OF NONSMALL CELL LUNG-CANCER WITHOUT ENLARGED MEDIASTINAL LYMPH-NODES ON CT SCAN

Objective: The results of primary surgery for non-small cell lung canc er (NSCLC) with involved ipsilateral mediastinal or subcarinal lymph n odes (N2 disease) remains poor. However, several studies suggest that induction chemotherapy could increase long-term survival in patients w ith N2 disease, Therefore, accurate preoperative staging of the medias tinum remains of paramount importance for the treatment policy in pati ents with NSCLC. Enlarged mediastinal lymph nodes (MLN) on CT scan are positive in only half of the patients. Small lymph nodes can contain metastatic deposits of clinical importance. However, many surgeons bel ieve that a normal mediastinum at computed tomography allows them to c ancel their preoperative mediastinal exploration. It was the aim of th is study to evaluate the results of cervical mediastinoscopy in patien ts without enlarged MLN on CT scan. Methods: Between January 1990 and June 1994, 235 patients with potentially operable NSCLC underwent a ce rvical mediastinoscopy despite the absence of enlarged MLN on CT scan, MLN were considered enlarged if they were equal to or larger than 15 mm at their maximal cross-sectional diameter. Results: Cervical medias tinoscopy was positive in 47 patients (20%), In 21 patients, N2 diseas e was extranodal and in 16 patients more than one level was involved. Mediastinoscopy was positive in 9.5% of the cT1NO cases, in 17.7% of t he cT2NO lesions, in 31.2 and 33.3% of cT3NO or cT4NO tumors. respecti vely. After a negative cervical mediastinoscopy, resectability for unf oreseen N2 disease was as high as 95%. Conclusion: We recommend a cerv ical mediastinoscopy in every patient with potentially operable NSCLC. (C) 1997 Elsevier Science B.V.