Abstract
Background:The aim of this study was to evaluate the impact of video-assisted thoracoscopic surgery (VATS) in the diagnosis and therapy of clinical mediastinal lymphadenopathies.
Methods:In our Institute, from 1995 to 2001, 85 patients underwent VATS biopsy: 55 subjects (group 1) for suspected lung cancer (65%) and 30 (group 2) for unknown nodes enlargement (35%). Lymphonodes were considered suspected if > 1 cm by radiological imaging. We performed 83 thoracoscopic biopsies: 33 in level 5 (39%), 24 in level 6 (29%), 19 in level 7 (22%), and 7 in level 8 (8%).
Results:A histological analysis of frozen sections was made in every case. Twenty subjects underwent lung resection in one-time (24%). Histology in group 1 was adenocarcinoma in 28 cases, epidermoid carcinoma in 14, microcytoma in 9, and giant-cell carcinoma in 4. Ten patients were at stage I, 10 at stage II, 33 at stage III, and two at stage IV. Histology of group 2 was lymphoma in 18 cases, sarcoidosis in eight, and focal aspecific hyperplasia in four.
Conclusion:The usefulness of VATS allowed the pathological assessment of the presumed involved mediastinal lymph nodes in every patient and thus permitted to assure in all the cases the indicated therapeutic treatment.
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REFERENCES
Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959; 36: 342–52.
Pearson FG. Mediastinoscopy: a method of biopsy in the superior mediastinum. J Thorac Cardiovasc Surg 1965; 49: 11–22.
McNeill T, Chamberlain J. Diagnostic anterior mediastinotomy. Ann Thorac Surg 1966; 2: 532–9.
Ginsberg RJ. Evaluation of the mediastinum by invasive techniques. Surg Clin North Am 1987; 67: 1015–25.
Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997; 111: 1718–23.
World Health Organization. Cancer Pain Relief. Geneva: World Health Organization, 1996.
Mountain CF. Revisions in the International System for staging lung cancer. Chest 1997; 111: 1710–7.
Grant TH, Stoll MA, Kandallu M, Chambliss JF. Percutaneous needle biopsy of mediastinal masses using a computed tomography-guided extrapleural approach. J Thorac Imag 1998; 13: 14–9.
PP Brega Massone, B Conti, B Magnani, C Lequaglie, I Cataldo. Video-assisted thoracoscopic surgery (VATS) for diagnosis, staging and treatment of lung cancer with suspected mediastinal lymphadenopathy. Surg Laparosc Endosc Percutan Tech 2002; 12: 104–9.
Naghiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg 2001; 72: 362–5.
Yim APC. Video-assisted thoracoscopic management of anterior mediastinal mass. Surg Endosc 1995; 9: 1184–9.
Robinson LA, Dobson JR, Bierman PJ. Fallibility of transthoracic needle biopsy of anterior mediastinal mass. Thorax 1995; 50: 1114–6.
Zinzani PL, Corneli G, Cancellier A, et al. Core-needle biopsy is effective in the initial diagnosis of mediastinal lymphoma. Haematologica 1999; 84: 600–3.
Tahara RW, Lackner RP, Graver LM. Is there a role for routine mediastinoscopy in patients with peripheral T1 lung cancer. Am J Surg 2000; 180: 488–91.
Gurses A, Turna A, Bedirhan MA, et al. The value of mediastinoscopy in preoperative evaluation of mediastinal involvement in non-small cell lung cancer patients with clinical N0 disease. Mediastinal exploration by mediastinoscopy and mediastinotomy. Thorac Cardiovasc Surg 2002; 50: 174–7.
Daniels JM, Rijna H, Postmus PE, van Mourik JC. Mediastinoscopy as a standardised procedure for mediastinal lymph node staging in non-small cell lung carcinoma. Eur J Cardiothorac Surg 2001; 19: 377–8.
Lau CL, Harpole DH Jr., Patz E. Staging techniques for lung cancer. Chest Surg Clin N Am 2000; 10: 781–801.
Paris F, Garcia-Zarza A, Canto A, Moya JA, Blasco E, Ferrer G. Hilioscopy as staging procedure. Delarue and Eschapasse, editors. “International Trends in General Thoracic Surgery” Lung Cancer. Philadelphia: Saunders, 1985: 54–9.
Harewood GC, Wiersema MJ, Edell ES, Liebow M. Cost-minimization analysis of alternative diagnostic approaches in a modeled patient with non-small cell lung cancer and subcarinal lymphadenopathy. Mayo Clin Proc 2002; 77: 155–64.
Lin JC, Hazelrigg SR, Landreneau RJ. Video-assisted thoracic surgery for diseases within the mediastinum. Surg Clin North Am 2000; 80: 1511–33.
Demmy TL, Krasna MJ, Detterbeck FC, et al. Multicenter VATS experience with mediastinal tumors. Ann Thorac Surg 1998; 66: 187–92.
Sagawa M, Sato M, Sakurada A, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 2002; 73: 900–4.
Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 1993; 59: 653–6.
Maisey N, Cunningham D. Current therapy and future prospects in lymphoma. Expert Rev Anticancer Ther 2001; 1: 29–41.
Jindal SK, Gupta D, Aggarwal AN. Sarcoidosis in developing countries. Curr Opin Pulm Med 2000; 448–54.
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Massone, P.P.B., Lequaglie, C., Magnani, B. et al. The Real Impact and Usefulness of Video-Assisted Thoracoscopic Surgery in the Diagnosis and Therapy of Clinical Lymphadenopathies of the Mediastinum. Ann Surg Oncol 10, 1197–1202 (2003). https://doi.org/10.1245/ASO.2003.03.538
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DOI: https://doi.org/10.1245/ASO.2003.03.538