title: Does video-assisted mediastinoscopy offer lower false-negative rates for subcarinal lymph nodes compared with standard cervical mediastinoscopy?
abstract: OBJECTIVE
  Theoretically, video-assisted mediastinoscopy (VAM) offers improved staging of subcarinal lymph nodes (LNs) compared with standard cervical mediastinoscopy (SCM). Materials and
  
  
  METHODS
  Between 2006 and 2011, 553 patients (SCM, n = 293; VAM, n = 260) with non-small cell lung carcinoma who underwent mediastinoscopy were investigated. Mediastinoscopy was performed only in select patients based on computed tomography (CT) or positron emission tomography CT scans in our center.
  
  
  RESULTS
  The mean number of LNs and stations sampled per case was significantly higher with VAM (n = 7.65 ± 1.68 and n = 4.22 ± 0.83) than with SCM (n = 6.91 ± 1.65 and 3.92 ± 86.4; p < 0.001). The percentage of patients sampled in station 7 was significantly higher with VAM (98.8%) than with SCM (93.8%; p = 0.002). Mediastinal LN metastasis was observed in 114 patients by mediastinoscopy. The remaining 439 patients (203 patients in VAM and 236 in SCM) underwent thoracotomy and systematic mediastinal lymphadenectomy (SML). SML showed mediastinal nodal disease in 23 patients (false-negative [FN] rate, 5.2%). The FN rate was higher with SCM (n = 14, 5.9%) than with VAM (n = 9, 4.4%), although this difference was not statistically significant (p = 0.490). Station 7 was the most predominant station for FN results (n = 15). The FN rate of station 7 was found to be higher with SCM (n = 9, 3.8%) than with the VAM group (n = 6, 2.9%; p = 0.623).
  
  
  CONCLUSIONS
  FN were more common in mediastinoscopy of subcarinal LNs. VAM allows higher rates of sampling of mediastinal LN stations and station 7, although it did not improve staging of subcarinal LNs.
authors.affiliation: Department of Thoracic Surgery, Kars State Hospital, Kars, Merkez, Turkey.
authors.forename: Necati
authors.initials: N
authors.lastname: Citak
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Songul
authors.initials: S
authors.lastname: Buyukkale
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Kok
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Celikten
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Metin
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sayar
authors.affiliation: Department of Thoracic Surgery, Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, İstanbul, Zeytinburnu, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Gurses
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging / Q000379:methods*; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D014741:Video Recording