TY - JOUR
T1 - N2 lung cancer
T2 - Outcome in patients with false-negative computed tomographic scans of the chest
AU - Daly, B. D.T.
AU - Mueller, J. D.
AU - Faling, L. J.
AU - Diehl, J. T.
AU - Bankoff, M. S.
AU - Karp, D. D.
AU - Rand, W. M.
AU - Mark, J. B.D.
AU - McKneally, M. F.
AU - Faber, L. P.
PY - 1993
Y1 - 1993
N2 - Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan- Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.
AB - Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor. Twelve patients had central tumors, and 25 had peripheral tumors. Two of the patients in the central tumor group died postoperatively and only 2 others survived, whereas 12 of the 25 patients in the peripheral tumor group survived. Four of the 37 patients, 2 in each group, did not undergo resection, and all died. All but 2 of the 31 survivors who underwent resection received postoperative adjuvant x-ray therapy (23 patients), chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients). The projected 2-year and 5-year survivals (Kaplan- Meier) were 40% and 28% for patients overall, 46% and 31% for those whose tumors were resected, 40% and 20% for those with resected central tumors, and 52% and 45% for those with resected peripheral tumors. None of these differences was significant. Cell type, location or number of locations of involved nodes, and the average percentage or maximum percentage of mediastinal node that was involved with tumor did not influence survival. The high negative predictive index for computed tomographic staging of the mediastinal lymph nodes and the observed 2-year and 5-year survivals in patients with false-negative computed tomographic scans of the chest justifies definitive thoracotomy without mediastinoscopy in most patients with a normal mediastinum on computed tomographic scan.
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U2 - 10.1016/s0022-5223(19)34164-9
DO - 10.1016/s0022-5223(19)34164-9
M3 - Article
C2 - 8487569
AN - SCOPUS:0027193809
SN - 0022-5223
VL - 105
SP - 904
EP - 911
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -