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Vol.49 No.1 contents | Japanese/English |
 | Full Text of PDF (505K) Article in Japanese |
- Review Article -
Mediastinal Lymph Node Staging for Lung Cancer
Tsutomu Yasumitsu1, Duk-Soon Yang1, Etsuko Takeda1, Kohzi Fukai11Center of Chest Disease, Iseikai Hospital, Japan
While the diagnostic accuracy of CT scanning is limited CT is still the routine examination for mediastinal staging of lung cancer. Contrast-enhanced CT is also necessary for staging. PET shows superior results for staging compared with CT, but both tests depend on conditions and provide only complementary information. Diagnostic problems regarding PET are related to false positive and false negative results. However PET should be done particularly in cases of patients with enlarged (over 1 cm in short axis) mediastinal lymph nodes. Transbronchial needle aspiration accuracy depends on the study methods, technical factors and patient population. Endoscopic ultrasound-guided needle aspiration (EUS-NA) is useful for diagnosis of mediastinoscopically inaccessible regions. Endobronchial ultrasound-guided needle aspiration (EBUS-NA) requires technical training. The procedure is minimally invasive and yet is able to obtain tissue diagnosis. Video-assisted thoracic surgery is a "final" mediastinal staging procedure. Conclusively positive findings of mediastinal lymph node on imaging should be confirmed by biopsy to use employ correct staging methods. If the outcomes of EUS-NA, TBNA, EBUS-NA and trans-thoracic needle aspiration (TTNA) are all negative mediastinoscopy should be performed. Mediastinoscopy still remains as the gold standard for mediastinal staging for lung cancer but may largely be superseded in the future by less invasive methods.
key words: Lung cancer, Mediastinal lymph node, Staging, Review
JJLC 49 (1): 1-7, 2009
