La mediastinoscopia nella diagnostica delle malattie del torace e nella stadiazione del cancro del polmone: nostra esperienza di 253 casi.

Translated title of the contribution: Mediastinoscopy for diagnosis of diseases of the chest and staging of lung cancer: our experience in 253 cases

Paolo Scanagatta, Cinzia Bonadiman, Giovanni Falezzaa, Alberto Terzi, Giovanni Magnanelli, Cristiano Benato, Birgit Feil, Irene Spilimbergo, Sonia Pergher, Alessandro Lonardoni, Gaetano Furlan, Ettore Montresor, Francesco Calabrò

Research output: Contribution to journalArticle

Abstract

The main indications for cervical mediastinoscopy are preoperative staging of lung cancer and diagnostic biopsy of mediastinal mass (lymphoma, sarcoidosis, tuberculosis etc.). We undertook a retrospective review of our experience of mediastinal exploration by cervical media-stinoscopy: 253 mediastinoscopies were performed on 252 patients (195 male and 57 female; mean age 53 years, range 14-88 years) between 1995 and June 2003. Four extended mediastinoscopies were performed and 1 patient had a re-mediastinoscopy following a non-diagnostic procedure. 319 lymph nodal stations were investigated in 253 procedures. We observed no mortality, while 2 patients had major bleeding (0.7%), with the need for open surgical treatment in order to achieve haemostasis. The median length of hospital-stay was one day, with discharge in the first postoperative day. 69 out of 170 patients, who eventually resulted to be affected by a histologically proven lung cancer, had a negative mediastinoscopy. Fifteen of them resulted N2 at the time of surgery: 8 patients with a false negativity in a biopsied station (4 in station 4R and 4 in station 7), while 7 cases showed infiltration in stations which were not sampled (5 in station 5, 1 in station 8 and 1 in station 7, the latter being the only one in which a standard cervical mediastincoscopy could have been able to stage it correctly). So, having observed 61 true negatives and 8 false-negatives in the sampled stations, in our experience the negative predictive value of cervical mediastinoscopy was 88.4%, with 78.2% of patients correctly staged without using other diagnostic tools. In conclusion, mediastinoscopy is an important procedure for the diagnostic biopsy of mediastinal mass and a useful tool in preoperative staging of lung cancer, especially if associated with chest CT-scan and Positron Emission Tomography (PET). In our experience, the spreading of PET does not lead to a reduction of cervical mediastinoscopies, both for the contemporary introduction of new chemotherapeutic preoperative protocols and, above all, for the not negligible incidence of false-positive results using PET, suggesting that media-stinoscopy should always be performed in patients affected by a PET-positive mediastinal growth.

Translated title of the contributionMediastinoscopy for diagnosis of diseases of the chest and staging of lung cancer: our experience in 253 cases
Original languageItalian
Pages (from-to)177-182
Number of pages6
JournalChirurgia Italiana
Volume57
Issue number2
Publication statusPublished - Mar 2005

ASJC Scopus subject areas

  • Surgery

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    Scanagatta, P., Bonadiman, C., Falezzaa, G., Terzi, A., Magnanelli, G., Benato, C., Feil, B., Spilimbergo, I., Pergher, S., Lonardoni, A., Furlan, G., Montresor, E., & Calabrò, F. (2005). La mediastinoscopia nella diagnostica delle malattie del torace e nella stadiazione del cancro del polmone: nostra esperienza di 253 casi. Chirurgia Italiana, 57(2), 177-182.