Mediastinoskopi: Küçük Hücreli Dışı Akciğer Kanseri N-Evrelemesinde Hala Geçerli Mi Yoksa Değersiz Bir Yöntem Midir?

Year 2020, Volume: 42 Issue: 5, 496 - 503, 15.09.2020

Hakan Keskin , Şirin Akdeniz Baysal Emel Gündüz , Makbule Ergin , Gülay Özbilim

https://doi.org/10.20515/otd.643685

Abstract

Mediastinal lenf nodu metastazı, küçük hücreli dışı akciğer kanserinin
tedavisinde ve prognozunda önemli bir faktördür. Mediastinal lenf nodu
metastazının tespiti için en sık kullanılan pozitron emisyon tomografi (PET)
ile mediastinoskopinin karşılaştırılması yapıldı. PET’in mediastinal lenf nodu
metastazının saptanmasında altın standart olarak kullanılan mediastinoskopiye
alternatif bir yöntem olup olmadığı araştırıldı. Kliniğimizde 2012 ile 2017
yılları arasında küçük hücreli dışı akciğer kanseri tanısı alan 102 hasta
çalışmaya dahil edildi. Bu hastalardan alınan toplam 277 lenf nodu biyopsileri
histopatolojik sonuçları ve pozitron emisyon tomografisindeki tutulumları ile
karşılaştırıldı. PET’in negatif öngörücülük değeri %82,7, pozitif öngörücülük
değeri ise %69,5, duyarlılığı %66,6 iken özgüllüğü %84,5 olarak saptandı.
Sadece mediastinoskopi yapılan ve frozen sonucunda tutulum saptanmayan hastalarda
torakotomi ile yapılan lenf nodu diseksiyon sonuçları hastalar incelendiğinde
mediastinoskopinin negatif öngörücülük değeri %97 olarak saptandı.PET’de
tutulumu olmayan; 1 santimetreden küçük 46 adet istasyon ve 1 santimetreden
büyük 19 adet olmak üzere toplam 65 istasyon örneklendi. Bu lenf nodlarının
histopatolojik evrelemesinde metastaz saptanmadı. PET’inde mediastinal lenf
nodlarında tutulum olmayan hastalarda invaziv mediastinal lenf nodu
örneklemesinin gerekli değildir. Ancak gereksiz torakotomilerden korumak için,
PET’de mediastinal lenf nodlarının tutulumunun, malignite eşiğinin altında olsa
bile invaziv mediastinal lenf nodu örneklemesinin yapılması gerekmektedir

Keywords

Lenf nodu, mediastinal, mediastinoskopi, pozitron emisyon tomografisi

Mediastinoscopy: A Depreciated or Still Viable Method For N-Staging of Non-Small Cell Lung Cancer?

Abstract

This study compares the two
most frequently used methods, combined positron emission tomography-computed
tomography (PET/CT) and mediastinoscopy, in detecting mediastinal lymph node
metastases. It has been investigated whether PET/CT can be used as an
alternative method to mediastinoscopy which is considered the gold standard in
detecting mediastinal lymph node metastasis. Mediastinal lymph node metastasis
is an important factor in treatment and prognosis of non-small cell lung
cancer. A total of 102 patients diagnosed with non-small cell lung cancer by
our clinic between 2012 and 2017, were enrolled in the study. In total 277
lymph nodes were compared with respect to their histopathologic results and
their involvement in positron emission tomography. Specificity value of PET/CT
was detected as 84.5% while its negative predictive value, positive predictive
value and sensitivity were 82.7%, 69.5% and 66.6%, respectively. In patients
who underwent only mediastinoscopy and whose frozen section samples did not
demonstrate any metastatic involvement, when histopathological results of lymph
node dissection performed by thoracotomy were analyzed, the negative predictive
value of mediastinoscopy was calculated as 97%. In total 65 stations including
46 stations smaller than 1 centimeter and 19 stations larger than 1 centimeter,
which did not demonstrate any uptake in PET/CT, were sampled. No metastasis was
detected in histopathologic staging of these lymph nodes. For patients who do
not demonstrate any uptake in mediastinal lymph nodes on PET/CT, invasive lymph
node sampling is redundant. However, with the aim of avoiding unnecessary
thoracotomies, invasive lymph node sampling is required, even though
mediastinal lymph node uptake detected with PET/CT is below the threshold of
malignancy.

Keywords

Lymph node, mediastinal, mediastinoscopy, positron emission tomography

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