[The biopsying of at least 5 mediastinal lymph node stations for presurgical staging in patients with a non-small-cell lung carcinoma].
OBJECTIVE
To determine the additional value of mediastinoscopy/tomy in the pre-surgical staging of non-small-cell lung carcinoma.


METHODS
Retrospective.


METHODS
Patients who underwent mediastinoscopy/tomy for staging of non-small-cell lung carcinoma from 1994 to 2000 at Groningen University Hospital, the Netherlands, were evaluated. Starting with data on history, physical examination, data imaging tests and bronchoscopy, the additional value of the mediastinoscopy was then evaluated using a logistic regression model. Not only was the additional value of a limited, routinely performed mediastinoscopy (whereby only lymph nodes at the site of the primary tumour are biopsied) examined, but also that of the comprehensive standard mediastinoscopy (conforming to the minimal requirements regarding number and localization of biopsied lymph nodes, i.e. lymph-node stations 2L, 2R, 4R, 4L, 7). The outcome against which all the test results were measured was the result of final pathological tumour staging.


RESULTS
A total of 176 evaluable patients were included. History, physical examination and bronchoscopy played a small but significant role in predicting the percentage of patients in which resection was possible, 58% (95% CI: 50-67). Age was an important predictor. The subsequent addition of the limited and routinely performed mediastinoscopy to the model increased the correct prediction to 69% (95% CI: 61-77), while adding the standard mediastinoscopy to the model showed a significantly higher correct prediction of 81% (95% CI: 75-88).


CONCLUSIONS
The standard mediastinoscopy involving a minimum of five different lymph node stations was of greater diagnostic value than limited mediastinoscopy.
van Albada
M E
ME
Academisch Ziekenhuis Groningen, Postbus 30.001, 9700 RB Groningen.
Eldering
M J
MJ
Post
W J
WJ
Klinkenberg
T J
TJ
Timens
W
W
Groen
H J
HJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies