Lung cancer simultaneous primary verification and N-staging by video-mediastinoscopy
Gevorg S. Voskanyan, Ruben S. Stepanyan,
Shahen N. Danielyan
Department of Thoracic Surgery, Avdalbekyan National Institute of Health, Ministry of Health, Yerevan, Armenia
Department of General Surgery, Heratsi Yerevan State Medical University, Yerevan, Armenia
Department of Thoracic Surgery, Astghik Medical Center, Yerevan, Armenia
ABSTRACT
Introduction: Evaluation of affected mediastinal lymph nodes (N-staging) has a principal importance for the staging of lung cancers. There are numerous invasive methods for staging, among which video-mediastinoscopy has its important role. A biopsy of a metastatic lymph node is enough to perform complete histological, immunohistological and genetic studies.
Purpose: The purpose of the study was to show that in the presence of a lung tumor with involvement of the mediastinal lymph nodes on computed tomography (CT) images, when the histological diagnosis cannot be made by bronchoscopy, videomediastinoscopy allows for a biopsy with further histological diagnosis and simultaneous accurate staging.
Methods: The study was conducted retrospectively. Patients who underwent video-mediastinoscopy from January 2022 to April 2023 at the Thoracic Surgery Department of Astghik Medical Center were selected. In these patients were suspected central or peripheral lung cancer, affected mediastinal lymph nodes, without distant metastasis (M₀) according to CT and positron-emission tomography (PET/CT) scans, without histological diagnosis.
Results: The study included 22 patients with central and peripheral lung tumors, in whom cancer and pathological involvement of mediastinal lymph nodes were suspected according to CT and PET/CT scans. Lung cancer metastasis was found in lymph nodes of 20 out of 22 patients: 18 were non-small-cell carcinoma, and 2 were small-cell carcinoma. Lobectomy was performed in two patients after N₂ was excluded, and lung adenocarcinoma was diagnosed by postoperative histological examination: one pN2, the other pN0. No postoperative complications were reported from the performed video-mediastinoscopies. The duration of hospitalization was 8 to 24 hours.
Conclusion: In patients with lung tumor and suspected pathological involvement of mediastinal lymph nodes diagnosed by CT and PET/CT scans, video-mediastinoscopy can be the initial histological diagnostic method, at the same time providing an opportunity to perform cancer staging, reducing the number of invasive interventions and saving time to start treatment earlier.
Keywords: lung cancer, N-staging, video-mediastinoscopy, endoscopic/endobronchial ultrasound (EUS/EBUS)