Restaging the Mediastinum in Non-Small Cell Lung Cancer after Induction Therapy: Non-Invasive Versus Invasive Procedures

Abstract

Objective : Nodal status after induction therapy in patients with stage III non-small cell lung cancer (NSCLC) is an independent prognostic factor for survival. Prognosis is poor in patients with persisting mediastinal lymph node involvement.

Methods : From February 2000 to September 2007, restaging for NSCLC was performed in 25 patients (23 men, 2 women) by computed tomography (CT), positron emission tomography (PET) as well as repeat mediastinoscopy. Initial proof of N2 or N3 disease was obtained by mediastinoscopy.

Results : The non-invasive restaging modalities CT and PET had a rather low accuracy of 64% and 72%, respectively. Repeat mediastinoscopy performed better with an accuracy of 84%.

Conclusion : Histological proof of mediastinal involvement after induction therapy in NSCLC is necessary to select those patients who will benefit from surgical resection. When a first mediastinoscopy has been performed to obtain pathological proof of N2 or N3 disease, repeat mediastinoscopy proves to be more accurate than CT or PET scanning for mediastinal restaging.

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Notes on contributors

M. De Waele

M. De Waele, M.D. Department of Thoracic and Vascular surgery Antwerp University Hospital Wilrijkstraat 10 B-2650 Edegem, Belgium Tel.: [phone] Fax: [phone] E-mail: [email protected]