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Peter Goldstraw - One of the best experts on this subject based on the ideXlab platform.
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The role of Mediastinoscopy in superior vena caval obstruction
The Annals of thoracic surgery, 1995Co-Authors: Marjan Jahangiri, Peter GoldstrawAbstract:The role of Mediastinoscopy in superior vena caval obstruction is not defined. To examine the safety and efficacy of Mediastinoscopy, we reviewed 34 patients with superior vena caval obstruction who required Mediastinoscopy to establish a histologic diagnosis after less invasive techniques had failed. They were referred to one surgical team between 1982 and 1993. Of the 34 patients, 26 had lung cancer, 6 had lymphoma, 1 had malignant thymoma, and 1 had fibrosing mediastinitis. Definitive tissue diagnosis was obtained in all patients. There was one complication of Mediastinoscopy where arterial bleeding from the innominate artery occurred and limited sternotomy was required to control the bleeding. We conclude that Mediastinoscopy is a safe and effective technique for establishing histologic diagnosis in superior vena caval obstruction when less invasive techniques have been unsuccessful. The use of blind radiotherapy means that patients with lymphoma and small cell carcinoma will not receive optimum therapy with chemotherapy and patients with benign lesions will receive inappropriate therapy.
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Role of Mediastinoscopy in superior vena cava obstruction.
Cancer, 1993Co-Authors: Marjan Jahangiri, D. P. Taggart, Peter GoldstrawAbstract:BACKGROUND The role of Mediastinoscopy in superior vena cava obstruction (SVCO) is not clearly defined. The authors set out to examine the efficacy and safety of Mediastinoscopy in SVCO. METHODS They reviewed 14 patients referred to one surgical team over an 8-year period (1982-1990) who required Mediastinoscopy to establish a histologic diagnosis after other less invasive procedures had not established the diagnosis. RESULTS Of the 14 patients, 11 had lung cancer, 2 had lymphoma, and 1 had malignant thymoma. Definitive tissue diagnosis was obtained in 13 cases. Mediastinoscopy was unsuccessful in one of the cases because no pathologic tissue could be identified at the time of the procedure. Tissue diagnosis could only be obtained in this patient after mediastinotomy, and a lymphoma was found. There was one complication of Mediastinoscopy; one patient had arterial bleeding from the innominate artery that required limited sternotomy to control the bleeding. CONCLUSIONS The authors believe that Mediastinoscopy is a safe and effective technique for establishing a histologic diagnosis in SVCO when less invasive techniques have been unsuccessful. The use of blind radiation therapy cannot be justified on an emergency basis; failure to obtain a histologic diagnosis will result in up to 20% of patients receiving inappropriate radiation therapy, making subsequent tissue diagnosis very difficult.
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Mediastinoscopy 1992: is it still essential?
Lung Cancer, 1992Co-Authors: Peter GoldstrawAbstract:Surely no other surgical procedure has attracted the passion and sustained debate which has surrounded Mediastinoscopy. Thoracic surgeons even now, 33 years after its introduction, are divided on the role of this investigation. Those who argue in favour of Mediastinoscopy, and here I must declare my interest, believe it to be an essential staging investigation, to be considered in all cases of lung cancer prior to thoracotomy, providing valuable information as to whether pulmonary resection is (a) feasible and (b) desirable. Those who have not accepted Mediastinoscopy look upon it as an invasive investigation, with its own morbidity and occasional mortality, which is difficult to interpre.t, will delay and complicate thoracotomy and which does not provide useful prognostic information. These surgeons may on occasions undertake Mediastinoscopy to confirm mediastinal involvement and establish histological diagnosis where clinical or radiological features strongly suggest this possibility, but this is not the debate. The real issue is whether routine preoperative assessment of the mediastinum is necessary prior to thoracotomy for lung cancer, and whether mediastinal exploration by Mediastinoscopy and mediastinotomy helps in this respect. I can only comment on this debate from the biased perspective of a protagonist of Mediastinoscopy. I cannot hope to influence those who have established their own routine for the preoperative assessment of lung cancer, but will try to present to others the state of the art of Mediastinoscopy in 1992. Cervical Mediastinoscopy was first reported by Carlens in 1959 [l]. It was described as an endoscopic examination of the superior mediastinum through a short transverse cervical incision. The instrument is inserted beneath the pretracheal fascia, and dissection proceeds to the carina, allowing one to visualize and biopsy the lymph nodes in the right and left paratracheal regions, those in the pretracheal area and at the carina [2]. One can reach beneath the azygos vein to the nodes in the superior pole of the right hilum, and assess invasion into the right paratracheal area, and the left paratracheal area above the aortic arch. It will therefore be at its most sensitive in assessing mediastinal invasion and lymphatic spread of right upper lobe cancers [3]. When assessing tumours arising in the left upper lobe, or tumours which have reached the left main bronchus, cervical Mediastinoscopy should be supplemented by left anterior mediastinotomy to assess invasion or node involvement outside the aortic arch and into the sub-aortic fossa and anterior mediastinum [4,5].
Robert J. Cerfolio - One of the best experts on this subject based on the ideXlab platform.
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The Safety and Efficacy of Mediastinoscopy When Performed by General Thoracic Surgeons
The Annals of Thoracic Surgery, 2014Co-Authors: Benjamin Wei, Ayesha S. Bryant, Douglas J. Minnich, Robert J. CerfolioAbstract:Background Previous publications suggest that Mediastinoscopy only obtains a biopsy of lymph node tissue in about 50% of patients; however, those data included results from nonthoracic surgeons. Methods A retrospective cohort study was performed using a database of a consecutive series of patients who underwent Mediastinoscopy or video Mediastinoscopy by general thoracic surgeons only. Results Between January 1997 and September 2013, 1,970 patients underwent Mediastinoscopy (video Mediastinoscopy in the last 243). The indications were staging for known or suspected lung cancer in 68.5%. Morbidity occurred in 25 patients (1.3%). Significant bleeding occurred in 5 patients (0.25%): 2 patients required sternotomy, and bleeding in the other 3 was controlled with packing alone. No patients required transfusion. There were no 30-day operative deaths. Median operative time was 18 minutes, and 96.1% of operations were performed as outpatient procedures. Lymph node tissue was obtained from all patients, and biopsy specimens from at least two mediastinal stations were obtained for 98% who had non-small cell lung cancer. The false-negative rate for N2 lymph nodes that were accessible by Mediastinoscopy was 8.2% when lymph nodes dissected at the time of pulmonary resection were used as the reference standard. Conclusions In the hands of general thoracic surgeons Mediastinoscopy provides lymph node tissue from multiple stations essentially 100% of the time; has minimal morbidity and essentially no deaths; and is a short outpatient procedure. Specialty-specific data (and not national databases) should be used when the efficacy of Mediastinoscopy is compared with endobronchial ultrasound.
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endoscopic ultrasound guided fine needle aspiration in patients with non small cell lung cancer and prior negative Mediastinoscopy
The Annals of Thoracic Surgery, 2005Co-Authors: Mohamad A Eloubeidi, Ashutosh Tamhane, Victor K Chen, Robert J. CerfolioAbstract:Background Mediastinoscopy and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) are complementary for staging non-small cell lung cancer (NSCLC) patients. We assessed (1) the yield of EUS-FNA of malignant lymph nodes in NSCLC patients with combined anterior and posterior lymph nodes that had already undergone Mediastinoscopy and (2) the cost implications associated with alternative initial strategies. Methods All patients underwent chest computed tomography (CT) and/or positron emission tomography (PET), and Mediastinoscopy. Then, the posterior mediastinal stations (7, 8, and 9) or station 5 were targeted with EUS-FNA. The reference standard included thoracotomy with complete thoracic lymphadenectomy, repeat clinical imaging, or long-term clinical follow-up. A Monte Carlo cost-analysis model evaluated the expected costs and outcomes associated with staging of NSCLC. Results Thirty-five NSCLC patients met inclusion criteria (median age 65 years; 80% men). Endoscopic ultrasound-guided FNA was performed in 53 lymph nodes in various stations, the subcarinal station (7) being the most common (47.3%). Of the 35 patients who had a prior negative Mediastinoscopy, 13 patients (37.1%) had malignant N2 or N3 lymph nodes. Accuracy of EUS-FNA (98.1%) was significantly higher than that of CT (41.5%; p p Conclusions In patients with NSCLC and combined anterior and posterior lymph nodes, starting with EUS-FNA would preclude Mediastinoscopy in more than one third of the patients. Endoscopic ultrasound-guided FNA is a safe outpatient procedure that is less invasive and less costly than Mediastinoscopy.
Zhao Hui - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic value of Mediastinoscopy in superior vena cava obstruction syndrome
Chinese Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Zhao HuiAbstract:Objective To evaluate the efficacy and value of Mediastinoscopy in the diagnosis of superior vena cava obstruction syndrome (SVCOS). Methods 12 patients with SVCOS underwent Mediastinoscopy. This group consists of 9 males and 3 females aged 16 to 71 years. 7 cervical mediastinoscopies and 5 parasternal mediastinoscopies were performed. Results In eleven patients, definite pathological diagnosis was obtained, included: primary lung cancer in 8, lymphoma in 3 and invasive thymoma in 1. There were no operative morbidity and mortality. Only in 1 patient with lymphoma the symptom got worse after cervical Mediastinoscopy and soon released by chemotherapy. Conclusion Mediastinoscopy is an effective method in the diagnosis of SVCOS.It can be considered as a routine procedure if other methods failed.
Marjan Jahangiri - One of the best experts on this subject based on the ideXlab platform.
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The role of Mediastinoscopy in superior vena caval obstruction
The Annals of thoracic surgery, 1995Co-Authors: Marjan Jahangiri, Peter GoldstrawAbstract:The role of Mediastinoscopy in superior vena caval obstruction is not defined. To examine the safety and efficacy of Mediastinoscopy, we reviewed 34 patients with superior vena caval obstruction who required Mediastinoscopy to establish a histologic diagnosis after less invasive techniques had failed. They were referred to one surgical team between 1982 and 1993. Of the 34 patients, 26 had lung cancer, 6 had lymphoma, 1 had malignant thymoma, and 1 had fibrosing mediastinitis. Definitive tissue diagnosis was obtained in all patients. There was one complication of Mediastinoscopy where arterial bleeding from the innominate artery occurred and limited sternotomy was required to control the bleeding. We conclude that Mediastinoscopy is a safe and effective technique for establishing histologic diagnosis in superior vena caval obstruction when less invasive techniques have been unsuccessful. The use of blind radiotherapy means that patients with lymphoma and small cell carcinoma will not receive optimum therapy with chemotherapy and patients with benign lesions will receive inappropriate therapy.
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Role of Mediastinoscopy in superior vena cava obstruction.
Cancer, 1993Co-Authors: Marjan Jahangiri, D. P. Taggart, Peter GoldstrawAbstract:BACKGROUND The role of Mediastinoscopy in superior vena cava obstruction (SVCO) is not clearly defined. The authors set out to examine the efficacy and safety of Mediastinoscopy in SVCO. METHODS They reviewed 14 patients referred to one surgical team over an 8-year period (1982-1990) who required Mediastinoscopy to establish a histologic diagnosis after other less invasive procedures had not established the diagnosis. RESULTS Of the 14 patients, 11 had lung cancer, 2 had lymphoma, and 1 had malignant thymoma. Definitive tissue diagnosis was obtained in 13 cases. Mediastinoscopy was unsuccessful in one of the cases because no pathologic tissue could be identified at the time of the procedure. Tissue diagnosis could only be obtained in this patient after mediastinotomy, and a lymphoma was found. There was one complication of Mediastinoscopy; one patient had arterial bleeding from the innominate artery that required limited sternotomy to control the bleeding. CONCLUSIONS The authors believe that Mediastinoscopy is a safe and effective technique for establishing a histologic diagnosis in SVCO when less invasive techniques have been unsuccessful. The use of blind radiation therapy cannot be justified on an emergency basis; failure to obtain a histologic diagnosis will result in up to 20% of patients receiving inappropriate radiation therapy, making subsequent tissue diagnosis very difficult.
Yong Soo Choi - One of the best experts on this subject based on the ideXlab platform.
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endobronchial ultrasound versus Mediastinoscopy for mediastinal nodal staging of non small cell lung cancer
Journal of Thoracic Oncology, 2015Co-Authors: Hong Kwan Kim, Yong Soo Choi, Young Mog Shim, Keunchil Park, Sinho Jung, Joungho Han, Kyungjong Lee, Hye Yun Park, Myungju Ahn, Yong Chan AhnAbstract:Introduction Correct mediastinal staging is critical for determination of the most appropriate management strategy in patients with non–small-cell lung cancer (NSCLC). The purpose of this study was to compare the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with that of Mediastinoscopy in patients with NSCLC. Methods A prospective trial was conducted in a tertiary referral center in Korea. Patients with histologically proven NSCLC and suspicion for N1, N2, or N3 metastasis were enrolled. Each patient underwent EBUS-TBNA followed by Mediastinoscopy. Surgical resection and complete lymph node dissection were conducted in patients for whom no evidence of mediastinal metastasis was apparent after Mediastinoscopy. Results In total, 138 patients underwent EBUS-TBNA and 127 completed both EBUS-TBNA and Mediastinoscopy. N2/N3 disease was confirmed in 59.1% of the patients. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) of EBUS-TBNA on a per-person analysis were 88.0%, 100%, 92.9%, 100%, and 85.2%, respectively. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and NPV of Mediastinoscopy on a per-person analysis were 81.3%, 100%, 89.0%, 100%, and 78.8%, respectively. Significant differences in the sensitivity, accuracy, and NPV were evident between EBUS-TBNA and Mediastinoscopy ( p Conclusions EBUS-TBNA was superior to Mediastinoscopy in terms of its diagnostic performance for mediastinal staging of cN1–3 NSCLC. Because EBUS-TBNA is both less invasive and affords superior diagnostic sensitivity, it should be the first-line procedure performed in patients with NSCLC.
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outcomes of Mediastinoscopy and surgery with or without neoadjuvant therapy in patients with non small cell lung cancer who are n2 negative on positron emission tomography and computed tomography
Journal of Thoracic Oncology, 2011Co-Authors: Hong Kwan Kim, Yong Soo Choi, Young Mog Shim, Kwhanmien Kim, Keunchil Park, Yong Chan Ahn, Kyung Soo Lee, Joon Young Choi, Jhingook KimAbstract:Introduction: The objectives of this study were (1) to assess the results of Mediastinoscopy and mediastinal lymphadenectomy and (2) to compare outcomes of surgical treatment with or without neoadjuvant therapy in patients with non-small cell lung cancer who are N2 negative on integrated positron emission tomography and computed tomography (PET/CT). Methods: This was a retrospective, single-institution review of patients with non-small cell lung cancer who were N2 negative on CT and PET/CT. All patients underwent Mediastinoscopy; if N2 positive, patients underwent neoadjuvant therapy followed by pulmonary resection, and if N2 negative, patients underwent pulmonary resection with mediastinal lymphadenectomy. Results: Between 2003 and 2007, there were 750 patients (547 men). Of these, 51 patients were N2 positive at Mediastinoscopy and then underwent neoadjuvant therapy (Mediastinoscopy N2 group), and 699 were N2 negative at Mediastinoscopy and then underwent mediastinal lymphadenectomy. Mediastinal lymphadenectomy revealed that 635 had N0 or N1 disease (N2-negative group), and 64 had N2 disease (surgery N2 group). Overall 5-year survival was 73% for the N2-negative group, 44% for the surgery N2 group, and 47% for the Mediastinoscopy N2 group. Disease-free 5-year survival was 59% for the N2-negative group, 27% for the surgery N2 group, and 29% for the Mediastinoscopy N2 group. Conclusions: We found that there were no significant differences in overall and disease-free survivals between the surgery N2 group and the Mediastinoscopy N2 group. The benefit of neoadjuvant therapy in patients with PET/CT-negative but Mediastinoscopy-positive N2 disease should be confirmed by randomized studies.
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Mediastinoscopy in patients with clinical stage i non small cell lung cancer
The Annals of Thoracic Surgery, 2003Co-Authors: Yong Soo Choi, Young Mog Shim, Jhingook Kim, Kwhanmien KimAbstract:Abstract Background The aim of this study was to investigate the significance of Mediastinoscopy for clinical stage I non–small cell lung cancer. Methods We reviewed 291 patients who underwent Mediastinoscopy from January 1995 to December 2001 for clinical stage I non–small cell lung cancer. The patients who presented tumor-negative lymph nodes on Mediastinoscopy underwent thoracotomy for pulmonary resection and mediastinal lymph node dissection in the same operative session. Mediastinoscopy-positive patients were referred for neoadjuvant therapy. Results Of the 291 patients, 20 patients (6.9%) were found with N2 or N3 disease on Mediastinoscopy. Among 271 Mediastinoscopy-negative patients, thoracotomy-proven N0 was found in 201 patients (74.2%), N1 in 44 patients (16.2%), and N2 in 25 patients (9.2%). Seventeen of 25 patients with unforeseen N2 disease had positive lymph nodes in the station that could be approached by Mediastinoscopy only. The positive rate of Mediastinoscopy was significantly higher in the patients with nonbronchioloalveolar-type adenocarcinoma than in squamous cell carcinoma (11.5% vs 3.3%, p = 0.013). However, there was no difference in the Mediastinoscopy-positive rate between clinical T1 and T2 status. Conclusions Though there are still controversies about routine Mediastinoscopy in patients without mediastinal nodal enlargement on chest computed tomography scan, this study demonstrates that routine Mediastinoscopy is necessary, especially for nonbronchioloalveolar-type adenocarcinoma patients.