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Role of the Medistionscopy in the Lung Cancer
Prof
Bassam Darwish
- Lung cancer more commonly spreads to the mediastinum
than to other anatomic sites.
- Mediastinoscopy is the “gold standard” method
for assessing lung cancer mediastinal involvement, and allows selection
of patients who are at risk for earlier recurrence and poorer lung
cancer survival and reduces the likelihood for a futile thoracotomy.
The lecture includes: Techniques to assess the anterior mediastinum,
indications , contraindications, Complications and mortality rate
of the mediastionscopy.
We introduce our experience in the mediastionscopy
at Almouassat university hospital in Damascus - Syria.
- Conclusion: patients who have enlarged or suspicious
appearing mediastinal nodes on CT and/or those with FDG-PET or PET/CT
uptake, an EUS and/or EBUS can be performed to confirm the presence
of disease.
- If metastatic disease is not found, or in the cases
of Adenoscarcinomas and large cell cancers or central or lesions
larger than 4 cm or clinically N1 patients or in whom the SUV of
the primary is larger than 7, then the prevalence of mediastinal
involvement is higher, mediastinoscopy should be performed.
- For those patients with a negative mediastinum
on PET and CT and if the lesion is peripheral, in the outer third
of the lung field and the SUV of the primary is less than 2.5,
then mediastinoscopy is unlikely to provide.
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