Barendregt W B, Deleu H W, Joosten H J, Berg W, Janssen J P
Department of General Surgery, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
Eur J Cardiothorac Surg. 1995;9(11):655-8. doi: 10.1016/s1010-7940(05)80113-7.
Computed tomography (CT) is the non-invasive staging procedure of choice for assessment of metastasis to mediastinal lymph nodes in patients with bronchial carcinoma. Cervical mediastinoscopy can provide histologic evidence of mediastinal spread to the peritracheal, tracheobronchial and subcarinal lymph nodes. Sub-aortic and para-aortic nodes cannot be sampled via this route. The present study was performed to assess the staging value of the parasternal mediastinoscopy as a separate entity. Cervical and parasternal mediastinoscopy was performed in 37 patients with a proven diagnosis of non-small cell carcinoma of the left upper lobe. In 16 patients lymph node or tumor tissue could be biopsied via the parasternal route, in 21 patients no parasternal biopsy was taken. Of the 16 cases with biopsies, only one was positive (6%). Histologic examination of lymph node biopsy tissue was false negative in one other patient (6%). Of the 21 patients without biopsies taken during parasternal mediastinoscopy, three (14%) had proven lymphogenic spread to the subaortic and para-aortic nodes, detected at thoracotomy. The parasternal procedure changed treatment in only one patient (3%). Diagnostic sensitivity was 20%. It is concluded that parasternal mediastinoscopy should not be used as a routine staging procedure in patients with left upper lobe lung cancer.
计算机断层扫描（CT）是评估支气管癌患者纵隔淋巴结转移的首选非侵入性分期检查方法。颈部纵隔镜检查可提供纵隔扩散至气管周围、气管支气管和隆突下淋巴结的组织学证据。主动脉下和主动脉旁淋巴结无法通过此途径进行活检。本研究旨在评估胸骨旁纵隔镜检查作为一种独立检查方法的分期价值。对37例经证实为左上叶非小细胞癌的患者进行了颈部和胸骨旁纵隔镜检查。16例患者可通过胸骨旁途径获取淋巴结或肿瘤组织活检，21例患者未进行胸骨旁活检。在16例活检病例中，只有1例呈阳性（6%）。另一例患者的淋巴结活检组织组织学检查为假阴性（6%）。在21例胸骨旁纵隔镜检查时未进行活检的患者中，3例（14%）在开胸手术时被证实有主动脉下和主动脉旁淋巴结的淋巴源性转移。胸骨旁检查仅使1例患者（3%）的治疗方案发生改变。诊断敏感性为20%。结论是，胸骨旁纵隔镜检查不应作为左上叶肺癌患者的常规分期检查方法。
