The Role of Extended Cervical Mediastinoscopy in Staging of Non-small Cell Lung Cancer of the Left Lung and a Comparison with Integrated Positron Emission Tomography and Computed Tomography: Does Integrated Positron Emission Tomography and Computed Tomography Reduce the Need for Invasive Procedures?

Objective Extended cervical mediastinoscopy (ECM) is a method for sampling aortopulmonary window (APW) mediastinal lymph nodes. In this study, the efficacy of integrated positron emission tomography/computed tomography (PET/CT) was compared with ECM for the detection of APW lymph node metastasis. Methods Fifty-five patients diagnosed of non-small cell lung cancer in whom APW or hilar lymph nodes had been reported to be positive on PET/CT, and/or who had had central tumor and/or in whom ECM had been performed for mediastinal staging due to the presence of APW lymph nodes larger than 1 cm in diameter on the CT between 2005 and 2009, were retrospectively analyzed. All patients underwent PET/CT scanning. Results Thirty-eight patients were identified as cN0 by standard cervical mediastinoscopy/ECM, and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 19, 13, and six of these patients, respectively. Mediastinal lymphadenectomy revealed APW lymph node metastases in four patients (ECM false negative). Seventeen patients identified as cN2 by mediastinoscopy, APW lymph node metastasis was present in nine, whereas eight had mediastinal lymph node metastasis that could only be accessed by standard cervical mediastinoscopy but had no APW lymph node metastasis were excluded from the analysis. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of ECM/PET/CT were calculated as 0.69/0.53, 1/0.91, 0.89/0.83, 1/0.70, and 0.91/0.80, respectively. Conclusions ECM, which is an effective technique used in the determination of APW lymph node metastasis, was enough to rule out nodal disease with negative predictive value. PET/CT does not reduce the need for invasive procedures in detecting APW lymph node metastasis.