Çağatay TEZEL, İlker İSKENDER, Salih Zeki KADIOĞLU, Altan KIR

The role of standard and extended cervical mediastinoscopy in the staging of non-small cell lung cancer patients

Amaç: Bu çalışmada küçük hücreli dışı akciğer kanserinin (KHDAK) ameliyat öncesi evrelemesinde uyguladığımız standart servikal mediastinoskopi (SSM) ve genişletilmiş servikal mediastinoskopi (GSM) deneyimimiz aktarıldı. Çalışma planı: Eylül 2005 ila Aralık 2007 tarihleri arasında KHDAK tanısı veya öntanısı ile kliniğimize başvuran ardışık 208 hasta değerlendirildi. Neoadjuvan tedavi uygulanan (n=7) ve anormal morfoloji nedeni ile mediastinoskopi yapılamayan (n=5) toplam 12 hasta çalışmadan çıkarıldı. Tüm hastalara standart servikal mediastinoskopi ve sol akciğer tümörü bulunan 47 hastaya eşzamanlı GSM ve SSM uygulandı. Mediastinoskopi sonucu negatif olan hastalara torakotomi uygulandı. Bulgular: Patoloji sonuçları, SSM ile değerlendirilen 676 lenf nodu ve GSM ile değerlendirilen 86 lenf nodu ile karşılaştırıldı. Standart servikal mediastinoskopi ve GSM’de 49 gerçek pozitif, 136 gerçek negatif ve 11 yalancı negatif sonuç saptandı. Bu sonuçlarla kombine mediastinoskopinin duyarlılığı, özgüllüğü, negatif öngörü değeri ve etkinliği sırasıyla %81.7, %100, %92.5 ve %94.4 olarak hesaplandı. Sonuç: Biz KHDAK’nin evrelemesinde, diğer noninvazif işlemlere ulaşılamayan durumlarda, SSM ve GSM’nin “mediastinoskopi” başlığı altında birlikte sınıflandırılmasını öneriyoruz.

Küçük hücreli dışı akciğer kanseri hastalarının evrelemesinde standart ve genişletilmiş servikal mediastinoskopinin rolü

Background: In this study, our experience with standard cervical mediastinoscopy (SCM) and extended cervical mediastinoscopy (ECM)-performed for preoperative staging of non-small cell lung cancer (NSCLC) is presented. Methods: Two hundred and eight consecutive patients with the diagnosis or prediagnosis of NSCLC admitted to our clinic between September 2005 and December 2007 were evaluated. Twelve patients were excluded from the study due to neoadjuvant treatment (n=7) and abnormal morphology preventing proper mediastinoscopy (n=5). Standard cervical mediastinoscopy was performed in all patients and concurrent ECM and SCM in 47 patients who had a tumor in the left lung. We performed thoracotomies in patients with a negative mediastinoscopy result. Results: The pathological results were compared with 676 lymph nodes which were evaluated with SCM and 86 lymph nodes which were evaluated with ECM. Forty-nine true-positive, 136 true-negative, and 11 false-negative results were found in SCM and ECM. With these results, the sensitivity, specificity, negative predictive value, and accuracy for combined technique were calculated as 81.7%, 100%, 92.5% and 94.4%, respectively. Conclusion: We recommend that SCM and ECM should be classified together under “mediastinoscopy” in the staging of NSCLC when other non-invasive procedures are unavailable.

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