Invasive techniques in diagnosis and staging of lung cancer
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Hellenic Journal of Surgery (2014) 86:3, 129-136
Invasive Techniques in Diagnosis and Staging of Lung Cancer S. Nikolouzos, G. Zacharia, A. Charpidou, A. Mouzakiti, K. Pagratis, E. Papanikolaou, N. Gatsoulis, A. Lioulias, K.Ν. Syrigos
Abstract Aim-Background: During the staging process of lung cancer, accurate mediastinal lymph node staging is one of the
more important factors to affect patient outcome. Accurate staging of the disease is important not only in determining prognosis but also in deciding the optimal treatment plan. The most significant treatment decision is establishing which patients can benefit from surgical resection and which should receive chemotherapy, radiation, or both. This paper reviews indications and current data regarding minimally invasive approaches for diagnosis and staging of lung cancer. In addition, current advances in diagnostic endoscopy for lung cancer will be reviewed. Methods: A systematic literature search was performed to identify relevant reports. Studies and articles were identified
using online searches of the U.S. National Library of Medicine via www.pubmed.com. We limited our bibliographic search to include only articles from 2008 onward. Results: The thoracoscopic approach is currently considered the gold standard for the evaluation and treatment of
suspected or known pleural effusion and in the diagnosis of indeterminate pulmonary nodules. It also has a complementary role to cervical mediastinoscopy in the invasive staging of mediastinal lymph nodes. Its role continues to evolve with regard to the management of lung cancer. Conclusions: Mediastinoscopy has remained the ‘gold standard’ in invasive staging tests of the mediastinum. The classic way of invasively assessing the aortopulmonary window is the Chamberlain procedure, also known as an anterior mediastinotomy. Key words: MITS; VATS; EBUS; TBNA; FNA; mediastinoscopy; mediastinotomy
Introduction Lung cancer is the most common cancer-related cause of death worldwide. The stage of disease dictates the choice of therapy. Surgery is the most appropriate management S. Nikolouzos, N. Gatsoulis Department of Surgery, Corfu General Hospital, Corfu, Greece G. Zacharia Department of Anaesthesiology, Iaso General Hospital, Athens, Greece A. Charpidou, K.Ν. Syrigos Oncology Unit, 3rd Department of Medicine, Athens Medical School, Sotiria General Hospital, Athens, Greece A. Mouzakiti Oncologist, Corfu, Greece K. Pagratis, E. Papanikolaou Department of Pulmonary Medicine, Corfu General Hospital, Corfu, Greece A. Lioulias Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece Correspondent Author: Stefanos Nikolouzos M.D., Department of Surgery, Corfu General Hospital. Kontokali, 49100, Corfu, Greece. Tel.: ++302661360400, E-mail: [email protected] Received 12 Feb 2014; Accepted 22 March 2014 Hellenic Journal of Surgery 86
for patients in whom disease is confined to the lung and hilar lymph nodes. For patients with ipsilateral mediastinal lymph node metastases, the benefit of surgery as pr
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