Disease relevance of Mediastinoscopy

• In only four cases (10%) was a positive diagnosis other than tuberculosis established; in two (lymphoma and thymoma) mediastinoscopy confirmed preoperative suspicions, and saved only two more (with sarcoidosis and vascular anomaly) from unnecessary antituberculous treatment [1].
• Following mediastinoscopy, a prognostically orientated multimodality approach was chosen in selected small-cell lung cancer (SCLC) patients with hyperfractionated accelerated chemoradiotherapy (Hf-RTx) and definitive surgery (S) [2].
• Thirty-nine patients with mediastinoscopy stage IIIA, N2 non-small cell lung cancer received two cycles of MVP (mitomycin C, vindesine, cisplatin) [3].
• All six patients had tumor recovered by mediastinoscopy as demonstrated by pathologic examination and/or estrogen receptor assay, Therefore, the diagnosis of mediastinal metastases in breast cancer may be suggested by either chest roentgenograms, mediastinal tomography, or gallium scintigraphy [4].
• Preoperative mediastinoscopy is indicated if CT shows nodal metastases or if there are signs of tumour invasion, but not in CT-negative T1 or T2 tumour [5].

High impact information on Mediastinoscopy

• RESULTS: EGFR expression determined on 138 of 164 patients who underwent mediastinoscopy or mediastinostomy was 0 (22 patients), 1+ (27 patients), 2+ (28 patients), and 3+ (61 patients) [6].
• In T2 and T3 patients, the ICER of routine mediastinoscopy was more favorable ($42,800 and $53,400 per QALY gained, respectively) [7].
• PATIENTS AND METHODS: Following staging, including mediastinoscopy, 94 patients with inoperable LAD-NSCLC were treated preoperatively with chemotherapy (three courses of split-dose cisplatin and etoposide [PE]) followed by concurrent chemoradiotherapy (one course of PE combined with 45 Gy hyperfractionated accelerated radiotherapy) [8].
• PATIENTS AND METHODS: Thirty-nine patients with mediastinoscopy stage IIIA N2 NSCLC received two cycles of MVP [9].
• Cervical mediastinoscopy and anterior mediastinotomy in superior vena cava obstruction [10].

Chemical compound and disease context of Mediastinoscopy

• CONCLUSIONS: We conclude that: 1. the octreoscan scintigraphy in the follow-up of resected carcinoids can give false-positive results and 2. in consequence, the mediastinoscopy is a discriminating investigation in case of mediastinal lymph nodes disease [11].
• Fifty-two patients with proven primary lung cancer who were referred for mediastinoscopy were prospectively studied with Tc-99m glucoheptonate and Ga-67 citrate thoracic scintigraphy [12].

Anatomical context of Mediastinoscopy

• Lung cancer staging: the value of ipsilateral scalene lymph node biopsy performed at mediastinoscopy [13].
• The sensitivity of mediastinoscopy increased as the amount of disease present, as measured by the clinical stage of disease or positive gallium 67 scan of mediastinum, increased [14].

Associations of Mediastinoscopy with chemical compounds

• METHODS: Standard diagnostic workup included CT scan, bronchoscopy, bronchial biopsy or Fine Needle Aspiration Biopsy, (111)In-pentetreotide scan (OctreoScan) and mediastinoscopy in selected patients [15].

Gene context of Mediastinoscopy

• Mediastinoscopy is indicated in patients with serum CEA concentrations > or = 5.0 ng/mL and maximum tumor dimension > or = 20 mm, and not indicated in patients with serum CEA concentrations < 5.0 ng/mL and maximum tumor dimension < 20 mm [16].
• CONCLUSION: It was concluded that evaluation of CEA in addition to CT is of use in the diagnosis of N2 disease in NSCLC patients and should be used as an indication for mediastinoscopy [17].
• Mediastinoscopy in superior vena cava obstruction: analysis of 80 consecutive patients [18].
• Thirty-four patients with an aortic window lesion were carefully staged with gallium scans and mediastinoscopy according to the TNM classification system for carcinoma of the lung [19].
• All patients underwent pretreatment evaluation at the university's Multidisciplinary Lung Cancer Center. Most patients (87%) had complete mediastinoscopy staging, and all were believed to be poor candidates for up-front operation because of bulky extent of disease [20].

Analytical, diagnostic and therapeutic context of Mediastinoscopy

• A phase I/II dose escalation study of the combination of docetaxel and cisplatin as neoadjuvant treatment of patients with stage IIIa T1-T3 NSCLC with N2 disease on mediastinoscopy is ongoing [21].
• Three cycles of cisplatin (P) (60 mg/m2, days 1 + 7) and etoposide (E) (150 mg/m2, days 3 to 5 qd 22) were followed by one cycle of radiotherapy/chemotherapy (RTx/CTx) (45 Gy, 1.5 Gy bid/3 weeks with P 50 mg/m2 days 2 + 9/E 100 mg/m2 days 4 to 6) followed by repeat mediastinoscopy and surgery [22].
• METHODS: Sixty five patients with mediastinoscopy proven stage IIIA NSCLC received two cycles of preoperative MVP or VLB/P followed by thoracotomy followed by two further courses of chemotherapy [23].

References