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Invasive techniques in diagnosis and staging of lung cancer

  • Review Article
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the more important factors to affect patient outcome. Accurate staging of the disease is important not only in determining prognosis but also in deciding the optimal treatment plan. The most significant treatment decision is establishing which patients can benefit from surgical resection and which should receive chemotherapy, radiation, or both. This paper reviews indications and current data regarding minimally invasive approaches for diagnosis and staging of lung cancer. In addition, current advances in diagnostic endoscopy for lung cancer will be reviewed.

Methods

A systematic literature search was performed to identify relevant reports. Studies and articles were identified using online searches of the U.S. National Library of Medicine via www.pubmed.com. We limited our bibliographic search to include only articles from 2008 onward.

Results

The thoracoscopic approach is currently considered the gold standard for the evaluation and treatment of suspected or known pleural effusion and in the diagnosis of indeterminate pulmonary nodules. It also has a complementary role to cervical mediastinoscopy in the invasive staging of mediastinal lymph nodes. Its role continues to evolve with regard to the management of lung cancer.

Conclusions

Mediastinoscopy has remained the ‘gold standard’ in invasive staging tests of the mediastinum. The classic way of invasively assessing the aortopulmonary window is the Chamberlain procedure, also known as an anterior mediastinotomy.

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References

  1. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thor Onc 2011; 6:244–285

    Article  Google Scholar 

  2. Shrager JB. Mediastinoscopy: Still the Gold Standard. 2nd International Bi-Annual Minimally Invasive Thoracic Surgery Summit. Ann Thorac Surg 2010; 89:S2084–S2089

    Article  PubMed  Google Scholar 

  3. Yasufuku K, Pierre A, Darling G, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg 2011; 142:1393–1400

    Article  PubMed  Google Scholar 

  4. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for Staging Non-small Cell Lung Cancer Staging. Methods for NSCLC Diagnosis and Management of Lung Cancer: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2013; 143:S211–S250

    Article  Google Scholar 

  5. Anraku M, Miyata R, Compeau C, et al. Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better? Ann Thorac Surg 2010; 89:1577–1581

    Article  PubMed  Google Scholar 

  6. Carnochan M, Walker WS. Positron emission may underestimate the extent of thoracic disease in lung cancer patients. Eur J Cardiothorac Surg 2009; 35:781–785

    Article  PubMed  Google Scholar 

  7. Tasci E, Teze C, Orki A, et al. The role of integrated positron emission tomography and computed tomography in the assessment of nodal spread in cases with non-small cell lung cancer. ICVTS 2010; 10:200–203

    Google Scholar 

  8. Alberts WM. Introduction to the Third Edition: Diagnosis and Management of Lung Cancer: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2013; 143:S38–S40

    Article  Google Scholar 

  9. Rami-Porta R, Call S. Invasive staging of mediastinal lymph nodes: mediastinoscopy and remediastinoscopy. Thorac Surg Clin 2012; 22:177–189

    Article  PubMed  Google Scholar 

  10. Van Schil PE, Hendriks JMH, De Waele M, Lauwers P. Editorial comment: Mediastinal restaging: has the Holy Grail been found? Eur J Cardiothorac Surg 2010; 37:780–781

    Article  PubMed  Google Scholar 

  11. Lerut T, De Leyn P, Coosemans W, et al. Cervical videomediastinoscopy. Thorac Surg Clin 2010; 20:195–206

    Article  CAS  PubMed  Google Scholar 

  12. Obiols C, Call S, Rami-Porta R, et al. Extended cervical mediastinoscopy: mature results of a clinical protocol for staging bronchogenic carcinoma of the left lung. Eur J Cardiothorac Surg 2012; 41:1043–1046

    Article  PubMed  Google Scholar 

  13. Puri V, Meyers BF. Optimal Initial Pathologic Mediastinal Staging of Lung Cancer: EUS, EBUS, Mediastinoscopy. In: Difficult Decisions in Thoracic Surgery. Springer, London, 2011; pp. 67–75

    Chapter  Google Scholar 

  14. Detterbeck F, Puchalski J, Rubinowitz A, et al. Classification of the thoroughness of mediastinal staging of lung cancer. CHEST 2010; 137:436–442

    Article  PubMed  Google Scholar 

  15. Nikolouzos S, Lioulias A, Baltayiannis N, et al. Minimally invasive surgical techniques in diagnosis and treatment of lung cancer. HJS 2012; 84:113–119

    Google Scholar 

  16. Boffa DJ, Kosinski AS, Paul S, et al. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg 2012; 94:347–353

    Article  PubMed  Google Scholar 

  17. Wallace MB, Pascual JMS, Raimondo M, et al. Minimally Invasive Endoscopic Staging of Suspected Lung Cancer. JAMA 2008; 299:540–546

    Article  CAS  PubMed  Google Scholar 

  18. Annema JT, Tournoy KG, Rabe KF, et al. Lung cancer staging with minimally invasive endoscopic techniques. JAMA 2008; 299:2510

    Article  CAS  PubMed  Google Scholar 

  19. Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive Summary Diagnosis and Management of Lung Cancer: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2013; 143:S7–S37

    Article  Google Scholar 

  20. Annema JT, Van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy Vs Endosonography for Mediastinal Nodal Staging of Lung Cancer. A Randomized Trial. JAMA. 2010; 304:2245–2252

    Article  CAS  PubMed  Google Scholar 

  21. De Leyn P. Clinical value of ESTS guidelines on preoperative lymph node staging for NSCLC. Eur J Cardiothorac Surg 2011; 40:280–281

    PubMed  Google Scholar 

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Correspondence to Stefanos Nikolouzos.

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Nikolouzos, S., Zacharia, G., Charpidou, A. et al. Invasive techniques in diagnosis and staging of lung cancer. Hellenic J Surg 86, 129–136 (2014). https://doi.org/10.1007/s13126-014-0114-0

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  • DOI: https://doi.org/10.1007/s13126-014-0114-0

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