Call Sergi, Rami-Porta Ramon
Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
Department of Morphological Sciences, School of Medicine, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain.
Mediastinum. 2019 Jul 23;3:31. doi: 10.21037/med.2019.07.01. eCollection 2019.
The staging of mediastinal lymph nodes is essential for planning the most adequate treatment for patients with non-small cell lung cancer (NSCLC). For this reason, the current American and European guidelines recommend obtaining tissue confirmation of any mediastinal abnormality seen on chest computed tomography (CT) and positron emission tomography (PET). This can be done by endoscopic techniques, such as endobronchial ultrasonographic fine-needle aspiration (EBUS-FNA), esophageal ultrasonographic FNA (EUS-FNA), or a combination of the two (CUS). Traditionally, surgical methods have been reserved to validate the negative results of minimally invasive endoscopic techniques. However, based on the latest evidence, cervical mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy (VAMLA) have demonstrated their superiority over minimally invasive methods in terms of performance for those tumors with normal mediastinum [clinical (c) N0-1 by CT and PET]. Therefore, cervical mediastinoscopy and VAMLA should be considered in the staging algorithms of this particular subset of NSCLC, and in the other well-established indications.
纵隔淋巴结分期对于为非小细胞肺癌（NSCLC）患者制定最恰当的治疗方案至关重要。因此，当前美国和欧洲的指南建议，对于胸部计算机断层扫描（CT）和正电子发射断层扫描（PET）上发现的任何纵隔异常，都要获取组织学证实。这可以通过内镜技术来完成，如支气管内超声引导下细针穿刺活检（EBUS-FNA）、食管超声引导下细针穿刺活检（EUS-FNA）或两者联合（CUS）。传统上，手术方法一直用于验证微创内镜技术的阴性结果。然而，基于最新证据，对于纵隔正常的肿瘤（CT和PET显示临床（c）N0-1），颈部纵隔镜检查和电视辅助纵隔镜淋巴结切除术（VAMLA）在操作方面已显示出优于微创方法的优势。因此，在这一特定亚组NSCLC的分期算法以及其他公认的适应证中，应考虑采用颈部纵隔镜检查和VAMLA。
