title: Remediastinoscopy in restaging of lung cancer after induction therapy.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the feasibility and diagnostic value of repeat mediastinoscopy as part of the response-evaluation protocol of 2 phase II multimodality studies for either stage IIIA/B non-small cell lung cancer or small cell lung cancer.
  
  
  METHODS
  From January 1991 through December 1998, 104 patients (79 men and 25 women) with stage IIIA/B non-small cell lung cancer (84 patients) or small cell lung cancer (17 patients) were enrolled in 2 different multimodality trials and underwent remediastinoscopy after induction chemoradiotherapy. The median age was 56 years (range, 34-72 years). Sensitivity, specificity, accuracy, and predictive values of remediastinoscopy were calculated by using standard definitions.
  
  
  RESULTS
  Remediastinoscopy was feasible in 98% of cases. Mortality was nil, and morbidity very low (1.9%). Lymph node downstaging (N0) was observed in 84 patients, persisting N2 disease was observed in 15 patients, and N3 disease was observed in 5 patients. Sensitivity was 61%, specificity was 100%, and accuracy was 88%. Positive predictive and negative predictive values reached 100% and 85%, respectively. According to the results of remediastinoscopy, 81 patients underwent surgical intervention, 3 refused the operation, and an unnecessary thoracotomy could be avoided in the remaining 20.
  
  
  CONCLUSIONS
  Remediastinoscopy provides a histologic proof of mediastinal downstaging with high diagnostic accuracy, is technically feasible with low morbidity, and still remains a valuable tool, even in an era of highly sophisticated imaging and endoscopic procedures. Persisting nodal disease at repeat mediastinoscopy carries a poor survival in the majority of cases because of occult metastases, so that indication for surgical intervention in such an unfavorable group of patients should be evaluated very carefully.
authors: Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, Essen, Germany. alexmarra@yahoo.it
authors: Alessandro
authors: A
authors: Marra
authors: Ludger
authors: L
authors: Hillejan
authors: Sylvia
authors: S
authors: Fechner
authors: Georgios
authors: G
authors: Stamatis
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000473:pathology* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011878:Radiotherapy; D012086:Reoperation
chemical_list: D000970:Antineoplastic Agents