[What is the role of thoracoscopy in the preoperative staging of non-small cell bronchial cancer?].
It is of paramount importance to clearly separate the non small cell bronchogenic cancers involving the chest wall or the diaphragm (T3) and those metastasizing to the pleura (T4). In both events, surgery is either technically demanding or contraindicated. What is the contribution of thoracoscopy to diagnosis? Very few authors have used thoracoscopy in a restricted number of cases and with varying results to confirm tumoral extent to the chest wall. We are of opinion that this approach is only warranted in patients at major operative risk, in order to prevent an unprofitable thoracotomy. Concomitant pleural effusion as indication for thoracoscopy should be discussed with respect to the following data: 1) Among all bronchogenic cancers, 10% present with a concomitant pleural effusion detected on chest radiograms, 60% of which are metastatic. The significance of effusions disclosed by CT scan has not yet been established. 2) Pleural involvement inconsistently produces an effusion; the prevalence compiled from thoracotomies is varying according to the authors. 3) The sensitivity of thoracoscopy for the positive diagnosis of malignant effusions is about 95%. The concomitant pleural effusion is predictive of poor prognosis, but does not preclude operability. Cytology of thoracentesis specimens and pleural needle biopsy are the consistent first steps towards diagnosis; thoracoscopy should be restricted to the failures of these techniques.
Roeslin
N
N
Hôpital Civil, Service de chirurgie thoracique du CHRU de Strasbourg.
Kessler
R
R
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011300:Preoperative Care; D013906:Thoracoscopy
Quelle est la place de la thoracoscopie dans le bilan d'extension pré-opératoire du cancer bronchique non à petites cellules?