YASEMİN BİLGİN BÜYÜKKARABACAK, AYŞEN TASLAK ŞENGÜL, BİLGE CAN MEYDAN, BURÇİN ÇELİK, MEHMET GÖKHAN PİRZİRENLİ, SELÇUK GÜRZ, ZEYNEP PELİN SÜRÜCÜ, AHMET BAŞOĞLU

The risk of tumor cell dissemination in mediastinoscopy: a cytological study

Background/aim: Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. Materials and methods: The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. Results: The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre- and postbiopsy lavage samples were reported to be positive for malignancy. Conclusion: While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.

Anahtar Kelimeler:

Mediastinoscopy, lavage, cytology

The risk of tumor cell dissemination in mediastinoscopy: a cytological study

Keywords:

Mediastinoscopy, lavage, cytology,

PDF

___

Hasdıraz L, Özkaya M, Bilgin M, Oğuzkaya F. Video yardımlı mediastinoskopi: 65 hastalık deneyimimiz. Toraks Dergisi 2006; 7: 156‒158 (in Turkish).
Sivrikoz CM, Ak I, Simsek FS, Döner E, Dündar E. Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma? Thorac Cardiovasc Surg 2012; 60: 116–121.
Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s meta-analytic comparison of PET and CT. Radiology 1999; 213: 530–536.
Toloza EM, Harpole L, McCrory DC. Noninvasive staging of nonsmall cell lung cancer: a review of the current evidence. Chest 2003; 123: 137–146.
De Leyn P, Vansteenkiste J, Cuypers P, Deneffe G, Van Raemdonck D, Coosemans W, Verschakelen J, Lerut T. Role of cervical mediastinoscopy in staging of non-small cell lung cancer without enlarged mediastinal lymph nodes on CT scan. Eur J Cardiothorac Surg 1997; 12: 706–712.
Gdeedo A, Van Schil P, Corthouts B, Van Mieghem F, Van Meerbeeck J, Van Marck E. Prospective evaluation of computed tomography and mediastinoscopy in mediastinal lymph node staging. Eur Respir J 1997; 10: 1547‒1551.
Li XD, Yin JL, Liu WK, Ouyang X, Zhou Z, Qiao GB, Zhang JR. Value of positron emission tomography-computed tomography in the diagnosis of mediastinal lymph node metastasis of non- small cell lung cancer. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30: 506–508 (article in Chinese with English abstract).
Billé A, Pelosi E, Skanjeti A, Arena V, Errico L, Borasio P, Mancini M, Ardissone F. Preoperative intrathoracic lymph node staging in patients with non-small-cell lung cancer: accuracy of integrated positron emission tomography and computed tomography. Eur J Cardiothorac Surg 2009; 36: 440– 445.
Ventura E, Islam T, Gee MS, Mahmood U, Braschi M, Harisinghani MG. Detection of nodal metastatic disease in patients with nonsmall cell lung cancer: comparison of positron emission tomography (PET), contrast-enhanced computed tomography (CT), and combined PET-CT. Clin Imaging 2010; 34: 20–28.
Kirby T, Fell S. Mediastinoscopy. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg R, Hiebert C, Patterson GA, Urschel H, editors. Thoracic Surgery. New York, NY, USA: Churchill Livingstone; 2002. pp. 98‒103.
Guerra M. Video-mediastinoscopy is still the gold standard. Rev Port Pneumol 2014; 20: 52.
Ponn BR. Invasive diagnostic procedures. In: Shields TW, LoCicero J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th ed. Philadelphia, PA, USA: Lippincott Williams & Wilkins; 2005. pp. 299‒313.
Al-Sofyani M, Maziak DE, Shamji FM. Cervical mediastinoscopy incisional metastasis. Ann Thorac Surg 2000; 69: 1255‒1257.
Ashbaugh DG. Mediastinoscopy. Arch Surg 1970; 100: 568– 573.
Hoitsma HF, Tjho ETT, Cuesta MA. A late complication of a diagnostic mediastinoscopy. Thorax 1978; 33: 115–116.
Sullivan WD, Passamonte PM. Mediastinoscopy incision site metastasis: response to radiation therapy. South Med J 1982; 75: 1428.
Rate WR, Solin LJ. Mediastinoscopy incision metastasis: Implications for radiotherapeutic treatment. Cancer 1989; 63: 68–69.
Hoyer ER, Leonard CE, Hazuka MB, Wechsler-Jentzsch K. Mediastinoscopy incisional metastasis: a radiotherapeutic approach. Cancer 1992; 70: 1612–1615.
Mazza F, Ferrari E, Maineri P, Dozin B, Ratto GB. Pleural lavage cytology predicts recurrence and survival, even in early non-small cell lung cancer. Surg Today 2015; 45: 322‒328.