Mediastinal staging of lung cancer. Is mediastinoscopy still essential?

The significance of computed tomography of the thorax and mediastinoscopy in pretherapeutic mediastinal assessment for the staging of lung cancer remains controversial. The presents study was designed to establish a standard approach to cervical mediastinoscopy for otolaryngologists, who in Denmark traditionally are involved in the staging of non-small cell lung cancer. Sixty-four potentially operable patients with non-small cell lung cancer underwent thoracic computed tomography prior to bronchoscopy and cervical mediastinoscopy. Thirty-six of the 43 mediastinoscopically negative patients additionally underwent thoracotomy, which in 32 cases was considered curative. Mediastinoscopy alone established the lung cancer diagnosis in 20% of the patients. In diagnosing lymph node metastases in the superior mediastinum, a criterion of 10 mm for abnormal enlargement resulted in an overall sensitivity and specificity of mediastinal computed tomography of 72% and 85%, respectively, and the overall false-negative and false-positive rates appeared to be 18% and 25%, respectively. No clinicopathological characteristics could be identified that influenced the occurrence of mediastinal metastases or the accuracy of computed tomography. It is concluded that mediastinoscopy remains essential in the evaluation of patients with presumed or verified non-small cell lung cancer. For otolaryngologists, the strategy of routine cervical mediastinoscopy, performed under general anesthesia in the same procedure as bronchoscopy, is advocated as a standard approach to preoperative mediastinal assessment for the staging of non-small cell lung cancer.