Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium.
Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium.
Interact Cardiovasc Thorac Surg. 2021 Jan 22;32(2):270-275. doi: 10.1093/icvts/ivaa263.
The purpose of this study was to assess the quality of video-assisted cervical mediastinoscopy (VACM) in the staging of non-small-cell lung cancer (NSCLC) at the Antwerp University Hospital with a focus on test effectiveness indicators, morbidity and unforeseen pN2 results.
All consecutive VACM workups of cases of NSCLC performed between January 2010 and December 2015 were included to assess overall test quality and effectiveness. Quality assurance was performed in accordance with the recommendations of the European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons (ESTS) where appropriate.
A total of 168 video-assisted cervical mediastinoscopies were included. A total of 91.7% of the procedures were performed in accordance with the ESTS guideline. An unforeseen pN2 staging was identified in 10 anatomical lung resections (8.6%). Statistical analysis showed no significant association between VACM performed in accordance with the ESTS guideline and the presence of pN2 positive lymph nodes [χ2 (1) = 0.61; P = 0.57] and no association between VACM performed in accordance with the ESTS guideline and overall futile thoracotomy [χ2 (1) = 0.76; P = 0.50]. Calculations revealed a sensitivity of 81.8 [95% confidence interval (CI) 69.1-90.9], specificity of 100%, positive predictive value of 100%, negative predictive value of 91.9% (95% CI 86.6-95.2) and diagnostic accuracy of 94.1% (95% CI 89.33-97.11).
Overall, 91.7% of the VACM were performed in accordance with the ESTS guideline. This process resulted in a sensitivity of 81.8%, a negative predictive value of 91.9% and an unforeseen pN2 rate of 8.6%.
本研究旨在评估安特卫普大学医院使用视频辅助经颈纵隔镜（VACM）对非小细胞肺癌（NSCLC）进行分期的质量，重点关注检测有效性指标、发病率和意外 pN2 结果。
纳入 2010 年 1 月至 2015 年 12 月期间连续进行的所有 VACM 检查，以评估总体检测质量和有效性。质量保证根据欧洲胃肠道内镜学会（ESGE）和欧洲胸外科医师学会（ESTS）的建议进行，在适当情况下。
共纳入 168 例视频辅助经颈纵隔镜检查。91.7%的手术符合 ESTS 指南。在 10 例解剖性肺切除术中发现了意外的 pN2 分期（8.6%）。统计分析显示，符合 ESTS 指南的 VACM 与 pN2 阳性淋巴结的存在之间无显著相关性[χ2（1）=0.61；P=0.57]，符合 ESTS 指南的 VACM 与总体无效剖胸术之间也无相关性[χ2（1）=0.76；P=0.50]。计算结果显示，敏感性为 81.8%（95%CI 69.1-90.9），特异性为 100%，阳性预测值为 100%，阴性预测值为 91.9%（95%CI 86.6-95.2），诊断准确性为 94.1%（95%CI 89.33-97.11）。
总体而言，91.7%的 VACM 符合 ESTS 指南。这一过程的敏感性为 81.8%，阴性预测值为 91.9%，意外 pN2 发生率为 8.6%。
