Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 7/2020

01-07-2020 | NSCLC | Special Edition

Mediastinal staging: when and how?

Authors: Antonio D’Andrilli, Giulio Maurizi, Federico Venuta, Erino A. Rendina

Published in: General Thoracic and Cardiovascular Surgery | Issue 7/2020

Login to get access

Abstract

Mediastinal staging for lung cancer includes both the assessment of mediastinal lymph nodes status before treatment and the postoperative pathological staging obtained by lymph-node removal performed during surgery. In patients with early stage NSCLC, the aim is to exclude with the highest certainty and the lowest morbidity the presence of mediastinal node involvement. Before treatment, mediastinal staging is based on imaging techniques, endoscopic techniques, and surgical procedures. Final pathological staging is based on lymph-node removal performed with lung resection according with different modalities (sampling, systematic dissection, etc.) and various approaches (thoracotomy, VATS, robotic). Data and indications from literature evidences are reported and discussed.
Literature
1.
D’Andrilli A, Venuta F, Rendina EA. The role of lymphadenectomy in lung cancer surgery. Thorac Surg Clin. 2012;22(2):227–37.PubMed
2.
Osarogiagbon RU, Lee YS, Faris NR, Ray MA, Ojeabulu PO, Smeltzer MP. Invasive mediastinal staging for resected non-small cell lung cancer in a population-based cohort. J Thorac Cardiovasc Surg. 2019;158(4):1220–9.PubMedPubMedCentral
3.
Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e211S–e250S250S.PubMed
4.
The American Thoracic Society and The European Respiratory Society. Pretreatement evaluation of non-small-cell lung cancer. Am J Respiratory Crit Care Med. 1997;156(1):320–32.
5.
De Leyn P, Doomsb C, Kuzdzalc J, Lardinois D, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014;45:1–12.
6.
Miao H, Shaolei L, Nan L, Yumei L, Shanyuan Z, Fangliang L, Yue Y. Occult mediastinal lymph node metastasis in FDG-PET/CT node-negative lung adenocarcinoma patients: risk factors and histopathological study. Thorac Cancer. 2019;10(6):1453–60.PubMedPubMedCentral
7.
Wang J, Welch K, Wang L, Kong FM. Negative predictive value of positron emission tomography and computed tomography for stage T1–2N0 non-small-cell lung cancer: a meta-analysis. Clin Lung Cancer. 2012;13(2):81–9.PubMed
8.
Lee PC, Port LC, Korst RJ, Liss Y, Meherally DN, Altorki NK. Risk factors for occult mediastinal metastases in clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007;84(1):177–81.PubMed
9.
Hishida T, Yoshida J, Nishimura M, Nishiwaki Y, Nagai K. Problems in the current diagnostic standards of clinical N1 non-small cell lung cancer. Thorax. 2008;63(6):526–31.PubMed
10.
Wu LM, Xu JR, Gu HY, Hua J, Chen J, Zhang W, et al. Preoperative mediastinal and hilar nodal staging with diffusion-weighted magnetic resonance imaging and fluorodeoxyglucose positron emission omography/computed tomography in patients with non-small-cell lung cancer: which is better? J Surg Res. 2012;178(1):304–14.PubMed
11.
Garpestad E, Goldberg S, Herth F, Garland R, LoCicero J 3rd, Thurer R, et al. CT fluoroscopy guidance for transbronchial needle aspiration: an experience in 35 patients. Chest. 2001;119(2):329–32.PubMed
12.
Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, et al. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2015;48(1):1–15.PubMed
13.
von Bartheld MB, Versteegh MI, Braun J, Willems LN, Rabe KF, Annema JT. Transesophageal ultrasound-guided fine-needle aspiration for the mediastinal restaging of non-small cell lung cancer. J Thorac Oncol. 2011;6(9):1510–5.
14.
Lee HS, Lee GK, Lee HS, Kim MS, Lee JM, Kim HY, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of non-small cell lung cancer: how many aspirations per target lymph node station? Chest. 2008;134(2):368–74.PubMed
15.
Annema JT, Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA. 2010;304(20):2245–52.PubMed
16.
Yasufuku K, Pierre A, Darling G, de Perrot M, Waddell T, Johnston M, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142(6):1393–400.PubMed
17.
Wallace MB, Pascual JM, Raimondo M, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA. 2008;299(5):540–6.PubMed
18.
Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64(9):757–62.PubMed
19.
Chandra S, Nehra M, Agarwal D, Mohan A. Diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle biopsy in mediastinal lymphadenopathy: a systematic review and meta-analysis. Respir Care. 2012;57(3):384–91.PubMed
20.
Zhang R, Ying K, Shi L, Zhang L, Zhou L. Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis. Eur J Cancer. 2013;49(8):1860–7.PubMed
21.
Bousema JE, van Dorp M, Noyez VJJM, Dijkgraaf MGW, Annema JT, van den Broek FJC. Unforeseen N2 disease after negative endosonography findings with or without confirmatory mediastinoscopy in resectable non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Oncol. 2019;14(6):979–92.PubMed
22.
Gu P, Zhao YZ, Jiang LY, Zhang W, Xin Y. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. Eur J Cancer. 2009;45(8):1389–96.PubMed
23.
Cho JH, Kim J, Kim K, Choi YS, Kim HK, Shim YM. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy. Ann Thorac Surg. 2011;92(3):1007–111.PubMed
24.
25.
Cerfolio RJ, Bryant AS, Eloubeidi MA. Accessing the aortopulmonary window (#5) and the paraaortic (#6) lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg. 2007;84(3):940–5.PubMed
26.
Sebastián-Quetglás F, Molins L, Baldó X, Buitrago J, Vidal G, Spanish Video-assisted Thoracic Surgery Study Group. Clinical value of video-assisted thoracoscopy for preoperative staging of non-small cell lung cancer. A prospective study of 105 patients. Lung Cancer. 2003;42(3):297–301.PubMed
27.
Rendina EA, Venuta F, De Giacomo T, Moretti MS, Ibrahim M, Coloni GF. Biopsy of anterior mediastinal masses under local anesthesia. Ann Thorac Surg. 2002;74(5):1720–2.PubMed
28.
D’Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin. 2010;20(2):265–84.PubMed
29.
Hürtgen M, Friedel G, Toomes H, Fritz P. Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA)—technique and first results. Eur J Cardiothorac Surg. 2002;21(2):348–51.PubMed
30.
Kuzdzał J, Zieliński M, Papla B, Szlubowski A, Hauer Ł, Nabiałek T, et al. Transcervical extended mediastinal lymphadenectomy—the new operative technique and early results in lung cancer staging. Eur J Cardiothorac Surg. 2005;27(3):384–90.PubMed
31.
Witte B, Wolf M, Huertgen M, Toomes H. Video-assisted mediastinoscopic surgery: clinical feasibility and accuracy of mediastinal lymph node staging. Ann Thorac Surg. 2006;82(5):1821–7.PubMed
32.
De Leyn P, Stroobants S, De Wever W, Lerut T, Coosemans W, Decker G, et al. Prospective comparative study of integrated positron emission tomography-computed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy-proven stage IIIA-N2 Non-small-cell lung cancer: a Leuven Lung Cancer Group Study. J Clin Oncol. 2006;24(21):3333–9.PubMed
33.
D’Andrilli A, Venuta F, Rendina EA. Resection for patients initially diagnosed with N3 after response to induction therapy. In: Ferguson MK, editor. Difficult decisions in thoracic surgery: an evidence-based approach. New York: Springer; 2007. p. 128–139.
34.
Cerfolio RJ, Bryant AS, Ojha B. Restaging patients with N2 (stage IIIa) non-small cell lung cancer after neoadjuvant chemoradiotherapy: a prospective study. J Thorac Cardiovasc Surg. 2006;131(6):1229–355.PubMed
35.
Herth F, Annema J, Eberhardt R, Yasufuku K, Ernst A, Krasnik M. Endobronchial ultrasound with transbronchial needle aspiration for restaging the mediastinum in lung cancer. J Clin Oncol. 2008;26:3346–50.PubMed
36.
Szlubowski A, Zielinski A, Soja J, Annema J, Sosnicki W, Jakubiak M, et al. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging—a prospective trial. Eur J Cardiothorac Surg. 2010;37:1175–9.PubMed
37.
Stigt JA, Oostdijk AH, Timmer PR, Shahin GM, Boers JE, Groen HJ. Comparison of EUS-guided fine needle aspiration and integrated PET-CT in restaging after treatment for locally advanced non-small cell lung cancer. Lung Cancer. 2009;66(2):198–204.PubMed
38.
Stamatis G, Fechner S, Hillejan L, Hinterthaner M, Krbek T. Repeat mediastinoscopy as a restaging procedure. Pneumologie. 2005;59(12):862–6.PubMed
39.
Lardinois D, Schallberger A, Betticher D, Ris HB. Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non-small cell lung cancer. Ann Thorac Surg. 2003;75(4):1102–6.PubMed
40.
Jaklitsch MT, Gu L, Demmy T, Harpole DH, D'Amico TA, McKenna RJ, et al. Prospective phase II trial of preresection thoracoscopic mediastinal restaging after neoadjuvant therapy for IIIA (N2) non-small cell lung cancer: results of CALGB protocol 39803. J Thorac Cardiovasc Surg. 2013;146(1):9–16.PubMedPubMedCentral
41.
Zielinski M, Szlubowski A, Kołodziej M, Orzechowski S, Laczynska E, Pankowski J, et al. Comparison of endobronchial ultrasound and/or endoesophageal ultrasound with transcervical extended mediastinal lymphadenectomy for staging and restaging of non-small-cell lung cancer. J Thorac Oncol. 2013;8(5):630–6.PubMed
42.
Goldstaw P. International association for the study of lung cancer handbook in thoracic oncology. Florida: Editorial Rx Press; 2009.
43.
Keller SM, Adak S, Wagner H, Johnson DH. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg. 2000;70(2):358–65.PubMed
44.
Izbicki JR, Thetter O, Habekost M, et al. Radical systematic mediastinal lymphadenectomy in non-small cell lung cancer: a randomized controlled trial. Br J Surg. 1994;81:229.PubMed
45.
Sugi K, Nawata K, Fujita N, Ueda K, Tanaka T, Matsuoka T, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg. 1998;22(3):290–4.PubMed
46.
Wu Y, Huang ZF, Wang SY, Yang XN, Ou W. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer. 2002;36(1):1–6.PubMed
47.
Massard G, Ducrocq X, Kochetkova EA, Porhanov VA, Riquet M. Sampling or node dissection for intraoperative staging of lung cancer: a multicentric cross-sectional study. Eur J Cardiothorac Surg. 2006;30(1):164–7.PubMed
48.
Gajra A, Newman N, Gamble GP, Kohman LJ, Graziano SL. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol. 2003;21(6):1029–34.PubMed
49.
Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141(3):662–70.PubMedPubMedCentral
50.
Allen MS, Darling G, Pechet T, et al. Morbidity and mortality of major pulmonary resections in patients with early stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81:1013–20.PubMed
51.
Huang X, Wang J, Chen Q, Jiang J. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS ONE. 2014;9(10):e109979.PubMedPubMedCentral
52.
Kneuertz PJ, Cheufou DH, D'Souza DM, Mardanzai K, Abdel-Rasoul M, Theegarten D, et al. Propensity-score adjusted comparison of pathologic nodal upstaging by robotic, video-assisted thoracoscopic, and open lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg. 2019;158(5):1457–66.PubMed
Metadata
Title
Mediastinal staging: when and how?
Authors
Antonio D’Andrilli
Giulio Maurizi
Federico Venuta
Erino A. Rendina
Publication date
01-07-2020
Publisher
Springer Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 7/2020
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-019-01263-8

Other articles of this Issue 7/2020

General Thoracic and Cardiovascular Surgery 7/2020 Go to the issue

Special Edition

Precise sublobar lung resection for small pulmonary nodules: localization and beyond

Special Edition

Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling?

Special Edition

Bronchoscopic navigation and tissue diagnosis

Special Edition

Photodynamic therapy for central-type early-stage lung cancer

Special Edition

The diagnosis and treatment of lung cancer presented as ground-glass nodule

Special Edition

New T1 classification