title: Joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the evaluation of mediastinal lymph nodes in patients with non-small cell lung cancer.
abstract: OBJECTIVE
  To evaluate the efficacy of the joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the sampling of mediastinal lymph nodes in patients with non-small cell lung cancer (NSCLC) and candidates for pulmonary resection.
  
  
  METHODS
  Sixty-two patients diagnosed with NSCLC were submitted to cervical mediastinoscopy and video-assisted thoracoscopy. The samples obtained (from paratracheal chains, anterior and posterior subcarinal chains, paraesophageal chains and pulmonary ligament) were submitted to frozen section analysis. The following variables were also evaluated: age; gender; weight loss; diagnostic method; tomographic findings; histological type; staging; and location and size of the primary tumor.
  
  
  RESULTS
  In 11 patients, mediastinoscopy showed no involvement of the subcarinal chain, whereas such involvement was identified when video-assisted thoracoscopy was used: positive predictive value = 88.89% (95% CI: 51.75-99.72); negative predictive value = 94.34% (95% CI: 84.34-98.82); prevalence = 17.74% (95% CI: 9.2-29.53); sensitivity = 72.73% (95% CI: 39.03-93.98); and specificity = 98.77% (95% CI: 93.31-99.97). In 60% of the patients with involvement of the posterior subcarinal chain, the primary tumor was in the right inferior lobe. (p = 0.029)
  
  
  CONCLUSIONS
  The joint use of cervical mediastinoscopy and video-assisted thoracoscopy for the evaluation of posterior mediastinal lymph nodes proved to be an efficacious method. When there is no access to posterior chains by means of ultrasound with transbronchial or transesophageal biopsy, which dispenses with general anesthesia, this should be the method of choice for the correct evaluation of mediastinal lymph nodes in patients with NSCLC.
authors.affiliation: Department of Thoracic Surgery, University of Caxias do Sul Foundation General Hospital, Caxias do Sul, Brazil. darcyrp@terra.com.br
authors.forename: Darcy Ribeiro
authors.initials: DR
authors.lastname: Pinto Filho
authors.forename: Alexandre José Gonçalves
authors.initials: AJ
authors.lastname: Avino
authors.forename: Suzan Lucia Brancher
authors.initials: SL
authors.lastname: Brandão
authors.forename: Wilson Paloschi
authors.initials: WP
authors.lastname: Spiandorello
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum; D008875:Middle Aged; D013906:Thoracoscopy / Q000379:methods*