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Comparación de la Tomografía Axial Computarizada con el estudio anatomopatológico en el estadiaje ganglionar del cáncer de pulmón
López Mata,M.; Valencia Julve,J.; Bascón Santaló,N.; Velilla Millán,C.; Escó Barón,R.; García álvarez,M.;
Oncología (Barcelona) , 2005, DOI: 10.4321/S0378-48352005000700006
Abstract: purpose: to analise the sensitivity, specificity, and positive and negative predictive values of the computerized axial tomography (ct) in nodal stages of lung carcinoma. material and methods: thirty patients suffering from lung carcinoma were analysed between may 2003 and may 2004. ct screening of the thorax was made to all the patients. mediastinoscopy or lung resection samples plus systematic node dissection were performed, and the efficiency of ct analysed by comparing the obtained data with the histopathology results of nodal affection shown by mediastinoscopy and lymph node dissection. results: the sensitivity, specificity, and positive and negative predictive value of the computerized axial tomography (ct) for nodal staging involved in lung carcinoma were 72.2%, 100%, 100% and 70,6% respectively. conclusions: ct of the thorax is considered a usual imaging technique in lung carcinoma diagnosis; but in some cases it does not focalise correctly the nodal staging involved in lung carcinoma. in theses cases, it is necessarry to perform invasive techniques such as mediastinoscopy. at present, positron emission tomography (pet) is the technique that better permits to focalise the tumor offering the best data for the therapy of each patient, and avoiding invasive diagnosis techniques.
A mediastinoscopia no diagnóstico de doen?as intratorácicas
Júdice, Luiz Felippe;Mourad, Omar Moté Abou;Lima, Oriane Almeida Santana;Júdice, ?ngelo Mesquita;Diégues, Pedro Henrique M. Braga;Fernandes, Rodrigo Mota Pacheco;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000100009
Abstract: the cervical mediastinoscopy, developed by carlens in 1959 is used primarily to evaluate, before thoracotomy, the status of mediastinal limph nodes in patients with lung cancer. however, exploration of the anterior mediastinum by these techniques can also identify other diseases processes such as sarcoidosis, tuberculosis, mycotic granulomatous infections and neoplastic diseases involving the mediastinum such as lymphoma. ln this study we analyze the medical reports of 125 patients in which mediastinoscopy was performed for the diagnosis of intrathoracic diseases. the procedure was performed with general anesthesia and orotracheal intubation in all patients out in two, submitted to mediastinoscopy with local anesthesia. the surgical approaches used were: cervical (n=103). anterior (n=7) and cervical + anterior (n=15). there were 80 male and 45 female patients. the age ranged from 13 to 75 years. carcinoma was the most prevalent diagnosis obtained (36.8%), followed by lymphoma (16%) and sarcoidosis (14.4%). in nine patients the exam was inconclusive, being responsible for a 7.2% failure index of the method. in eleven patients presenting superior vena cava syndrome, mediastinoscopy was performed without aditional complications, except in one case in which symptoms worsenned. we conclude that mediastinoscopy is a safe procedure and it is a valuable tool for the diagnosis of paratracheal mediastinal masses and lymphadenomegalies.
Our Cases of Sarcoidosis Diagnosed by Mediastinoscopy; Western Black Sea Experience
Ali K?l??gün,Sami Karapolat,?zkan Saydam,Suat Gezer
Journal of Clinical and Analytical Medicine , 2012, DOI: 10.4328
Abstract: Aim: Sarcoidosis is a multisystemic disease, characterized by noncaseating granuloms, the aetilogy remains unknown. We have stated that sarcoidosis diagnosis used by mediastinoscopy and our patients evaluated by stage and clinical features. Material and Method: 38 cases with a diagnosis of sarcoidosis by mediastinoscopy in our clinics (University Hospitals of Western Black Sea) were retrospectively analyzed. Cases was staging according to posteroanterior chest x-rays. Admission complaints,Pulmonary Function Tests, diagnostic methods, disease stages, comorbid diseases, clinical and laboratory features of the patients were assessed. Results: 26 of the patients were female, 12 were male. Mean age was 49 and age range was between 24-71 years. Most common complaint at appeal was cough, and the most common radiological stage was 2. The most common biopsy taken from the lymph nodes was right paratracheal (2R, 4R) , the least common was the left paratracheal lymph nodes. There was no mortality. Complications developed 3 patients. Discussion: Sarcoidosis diagnoses usually settled was in stage 2 with hilar lymphadenomegalia and lung parenchymal infiltration. Mediastinoscopy in the diagnosis of sarcoidosis with mediastinal lymph node biopsy is an effective procedure with quick results, low morbidity and mortality rates.
Mediastinotomía anterior y mediastinoscopia cervical en el diagnóstico de las lesiones tumorales mediastinales
Fuentes Valdés,Edelberto;
Revista Cubana de Cirug?-a , 2005,
Abstract: in order to establish the histological diagnosis and the treatment to be applied in the mediastinal tumors, the surgical access is frequently needed. objective: to determine the value of the cervical mediastinoscopy and the anterior mediastinotomy in the diagnosis of tumoral lesions of the mediastinum. methods: 32 patients with expansive mediastinal lesions who underwent a mediastinal exploration to obtain tissular sample for biopsy and were treated from january 2002 to june 2004, were presented. the procedure was considered useful when the sample was enough for the histological study. results: 38 explorations of the mediastinum were carried out with diagnostic ends. an absolute predominance of lymphomas (75 %) was found. in 26 patients (81.2 %) the diagnosis was obtained during the first exploration, whereas in 6 (18.8 %), it was necessary to conduct a second exploration that in 3 cases consisted in a second anterior mediastinotomy, as well as a mean sternotomy , new cervical mediastinoscopy and video-assisted thoracoscopy to have a diagnosis in 100 % of the cases. a lesion of the internal mammary vein was produced in 3 occasions and pneumothorax in one. the superficial sepsis of the wound was the postoperative complication observed in 2 cases. there were no deaths related to the procedure. conclusions: the mediastinal exploration (cervical mediastinoscopy and anterior mediastionotomy) is effective when it is necessary to establish with a minimum morbidity and without mortality, the histological diagnosis of mediastinal expansive lesions, mainly before the suspicion of lymphoma
One of the Thoracic Surgery Procedures: Mediastinoscopy
Timu?in Alar
Turk Toraks Dergisi , 2010,
Abstract: Objective: Mediastinoscopy is a surgical procedure, developed and implemented today only by thoracic surgeon, which can be easily applied, with low morbidity and mortality, for diagnosis and treatment of lung diseases.Material and Method: In this study, 21 patients who underwent diagnostic standard cervical mediastinoscopy at the 3rd Thoracic Surgery Service in Antalya State Hospital between August 2004 and December 2007 were examined retrospectively.Results: The final diagnosis was obtained in 19 of 21 cases (90%). The most commonly detected disease was sarcoidosis in 8 cases (38%). In six (29%) patients in whom N2 disease were detected, unnecessary thoracotomy was avoided. There was no morbidity or mortality.Conclusion: Mediastinoscopy is a surgical procedure with low morbidity and mortality can be done easily except in advanced centers, with the detection of benign lesions and N2 disease can be reduce the workload of these centers.
A Case of Pericardial Cyst with an Atypical Location (Paratracheal) Which was Removed by Mediastinoscopy
ülkü Yaz?c?,Taner Ege,Erkmen Gülhan,?rfan Tastepe
Turk Toraks Dergisi , 2010,
Abstract: The incidence rate of pericardial cysts accounts for nearly 7% of all mediastinal cysts. They occur in one in 100.000 people. They may either be of congenital origin or acquired. Their most common location is the right anterior cardiophrenic angle. This is a report of a case who underwent mediastinoscopy for a 3x4 cm coelomic pericardial cyst with an atypical location in the paratracheal area. A paratracheal cyst was incidentally detected in a 41 year old male patient. The cyst was in the upper right mediastinum with a paratracheal location. The patient underwent mediastinoscopy and the cyst was completely removed. Postoperative pathology reported a coelomic pericardial cyst. The patient was discharged on the 3rd postoperative day. Mediastinoscopy is a less invasive method compared to median sternotomy, thoracotomy and VATS in a mediastinal cyst.
The Clinical Application of Video Mediastinoscopy and CT in the N Staging of Preoperative Lung Cancer
Zhiheng WANG,Weibo QI,Yong ZHU,Ruobai LIN
Chinese Journal of Lung Cancer , 2009,
Abstract: Background and objective Preoperative lung cancer with mediastinal lymph nodes metastasis can be diagnosed by vedio mediastinoscopy (VM) and CT. This study was to explore the value of VM and CT in the diagnosis of N staging of preoperative lung cancer, and to discuss the difference between the 2 methods. Methods 48 cases diagnosed of lung cancer by CT or PET-CT were examined by VM. The sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymph nodes metastasis was discussed. Results ①Under the examination of VM, 31 patients with the negative outcome received the direct operation, 14 patients with N2 received 2 courses of neoadjuvant chemotherapy before operation, 3 patients with N3 received chemotherapy and/or radiotherapy. ②Forty-one cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, which of CT were 66.7%, 53.8%, 58.5%, 45.5%, 73.7% (χ2=4.083, P=0.039), the difference between VM and CT was statistically significant. ③In this group, the complications of VM incidence rate is 2.08% (1/48), the case is pneumothorax. Conclusion VM is superior to CT in the diagnosis of N staging of preoperative lung cancer, it is safe and effective, and there will be a wide perspective for VM in thoracic surgery.
The value of mediastinoscopy in the staging of lung cancer with clinical N2 disease
Hui ZHAO,Jun WANG,Jun LIU,Jianfeng LI
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and objective To determine the value of mediastinoscopy in the mediastinal staging of lung cancer with clinical N2 disease. Methods We retrospectively reviewed 87 patients received mediastinoscopy for known or suspected lung cancer, including 83 cervical mediastinoscopies and 4 parasternal mediastinoscopies. All patients were staged clinical N2 for enlarged ipsilateral mediastinal and/or subcarinal lymph nodes (short axis > 1.0 cm)on computed tomography scan. Results Of the 87 patients, 61 cases proved N2 disease on mediastinoscopy. The other 26 mediastinoscopy-negative patients underwent thoracotomy for lung resection and mediastinal lymph node dissection in the same operative session. Final pathologic N staging were consistent for mediastinoscopic sampling and surgical dissection in 24 patients. N2 disease was found in 2 patients (false-negative of mediastinoscopy). The sensitivity, specificity, and accuracy of mediastinoscopy were 96.8%, 100%, and 97.7%, respectively. There was no mortality and only 1 complication(1.1%) for all 87 mediastinoscopic procedures. Conclusion Mediastinoscopy is a highly effective and safe procedure for the mediastinal staging of lung cancer with clinical N2 disease.
Mediastinoscopy in Assessing Mediastinal Lymphadenopathy and Lung Disease  [PDF]
Iskander Al-Githmi
Open Journal of Thoracic Surgery (OJTS) , 2017, DOI: 10.4236/ojts.2017.74008
Abstract: Background: Mediastinoscopy is the gold standard procedure for the pathological staging and diagnosis of mediastinal diseases. The aim of the study is to describe the significance of anterior cervical Mediastinoscopy in evaluating patients with mediastinal lymphadenopathy and lung parenchymal disease. Material and Methods: From January 2014 until June 2017 we conducted a retrospective study of 52 consecutive patients with mediastinal lymphadenopathy and lung parenchymal disease who underwent anterior cervical Mediastinoscopy. The main indications for cervical Mediastinoscopy were isolated mediastinal lymphadenopathy, undetermined lung mass with mediastinal lymphadenopathy, and the clinical staging of patients with lung cancer. Results: The study subjects consisted of 37 men and 15 women, aged 13 to 87 (mean age 50.8). Eight patients had mediastinoscopy for staging lung cancer, 27 patients had mediastinoscopy to diagnose isolated mediastinal lymphadenopathy, and 17 patients had mediastinoscopy for an undetermined lung parenchymal mass. Among the patients with isolated mediastinal lymphadenopathy, sarcoidosis was diagnosed in 6, tuberculosis in 9, reactive lymph nodes in 4, metastasis in 5 and lymphoma in 3. Lymph node metastasis (N2, N3) was found in 5 patients with lung cancer. There was no surgical-related mortality or morbidity. Conclusions: Mediastinoscopy is a safe and reliable procedure in diagnosing mediastinal diseases and is still the first choice among the investigative modalities in the clinical staging of bronchogenic carcinoma.
Endobronchial ultrasound guided fine needle aspiration versus transcervical mediastinoscopy in nodal staging of non small cell lung cancer: a prospective comparison study
Ruoyu Zhang, Christina Mietchen, Marcus Krüger, Bettina Wiegmann, Heiko Golpon, Sabine Dettmer, Axel Haverich, Patrick Zardo
Journal of Cardiothoracic Surgery , 2012, DOI: 10.1186/1749-8090-7-51
Abstract: From April 2008 to December 2009, 36 patients with mediastinal lymphadenopathy underwent simultaneous EBUS-FNA/ TM at our institution. Among them were 26 patients with confirmed or suspected NSCLC.A total of 133 samples were obtained by EBUS-FNA and 157 samples by TM. EBUS-FNA achieved significantly less conclusive, but more indeterminate pathological results in comparison to TM (78.7% vs. 98.6%, p?<?0.001; 14.9% vs. 1.4%, p?=?0.007). Less paratracheal nodes were sampled by EBUS-FNA (right: 46.2% vs. 88.5%, p?=?0.003; left: 23.1% vs. 65.4%, p?=?0.005), while sampling rates in the subcarinal localisation were comparable (96.2% vs. 80.8%, p?=?NS). Among patients with confirmed NSCLC and conclusive EBUS-FNA/ TM findings (n?=?18), the prevalence of N2/N3 disease was 66.7% (n?=?12) according to TM findings. Diverging nodal stages were found in five patients (27.8%). Three patients who were N2 negative in EBUS-FNA were upstaged to N2 or N3 by TM, two patients with N2 status in EBUS-FNA were upstaged to N3 by TM.Compared to TM, EBUS-FNA had a lower diagnostic yield and resulted in systematic mediastinal nodal understaging. At this point we suggest corroborating negative EBUS-FNA results by transcervical mediastinoscopy.
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