Preoperative Mediastinal Lymph Node Staging for Non-Small Cell Lung Cancer

Select type


Abdel Wahed Gdeedo

Department of Cardiothoracic Surgery, Tripoli Medical Centre Tripoli, Libya

JMJ 2009,Vol.9, No.2: 88-92


Accurate preoperative staging of mediastinal lymph nodes in patients with non- small cell lung cancer (NSCLC) is imperative. It will guide choices of treatment and determine prognosis and outcome. Over the last years, different techniques have been in practice. They vary in accuracy and procedure-related morbidity. For primary staging mediastinoscopy remains the gold standard for superior mediastinal lymph nodes. Invasive procedures can be omitted in patients with peripheral tumours and negative mediastinal positron emission tomography (PET) images. However, in cases of central tumours, PET hilar N1 disease, low fluorodeoxylucose uptake of the primary tumour and large lymph nodes on CT (16mm), invasive staging is indicated. A PET positive mediastinal finding should always be cytohistologically confirmed. Transbronchial needle aspiration (TBNA), ultrasound-guided bronchoscopy with fine needle aspiration (EBUS-FNA) and endoscopic esophageal ultrasound-guided fine needle aspiration (EEUS-FNA) are new techniques that provide cyto-histological diagnosis and are minimally invasive. Their specificity is high but the negative predictive value is low. Because of this, if they yield negative results, an invasive surgical technique is indicated. However, if fine needle aspiration is positive, this result may be valid as proof for N2 or N3 disease.

Keywords: Lung Cancer, Pre-operative staging, Mediastinal Lymph node, Mediastinoscopy