Mediastinoscopy for T1 non-small cell lung carcinoma

Objective: Mediastinoscopy remains the gold standard for invasive staging of patients with lung cancer. Yet, its necessity in patients with T1N0M0 particularly with peripheral localization is being questioned. In the present study, we compared the pathology reports of cases with T-1 non-small cell carcinoma (NSCLC) both after mediastinoscopy and thoracotomy, for the last 2 years and discussed the necessity of mediastinoscopy. Material and Methods: We retrospectively reviewed the records of 21 clinically T1N0M0 patients, between June 2004 and June 2006. Of the 21 patients, 16 were males (76.1%) and 5 were females (23.9%). Their ages differed from 47 to 71 years (median 61.4 years). In all patients, radiological T1N0M0 was confirmed by bronchoscopy. Tissue samples were obtained by transthoracic fine needle biopsy in 8 and by bronchoscopy in 13 patients. All patients underwent videomediastinoscopy by standard cervical mediastinoscopy technique under general anesthesia. Results: Mediastinoscopy reveiled that 4 patients (19%) had ipsilateral lymph node involvement (N2 positive). All were from mediastinal lymph node station no. 4 of the ipsilateral side of the tumors. Of 2 patients who had no tissue diagnosis before mediastinoscopy, I was found to have N2 epidermoid lung cancer, which was diagnosed and staged by mediastinoscopy. Seventeen patients whose mediastinoscopies were negative underwent surgical resection. No mortality occurred and the morbidity rate was 0.04% (1 patient with hoarseness that lasted for a few days). Conclusion: In our trial, mediastinoscopy was positive in 4 (19%) of 21 patients with clinical T1 NSCLC and without enlarged lymph nodes on computerized tomography. The number of patients in our trial is limited to compare the different histological cell types but owing to its low morbidity and mortality and its relative cost effectiveness we suggest that routine mediastinoscopy for invasive mediastinal staging should be performed for all patients with non-small cell carcinoma.