Yıllar içerisinde küçük hücreli dışı akciğer kanserinin mediastinal evrelemesinde, servikal mediastinoskopi endikasyonu ve sonuçlarında neler değişti?

Abstract

Amaç: Bu çalışmanın amacı, yıllar içinde teknoloji ve tanı yöntemlerinde yaşanan gelişmeler sonucunda servikal mediastinoskopi (MK) endikasyon ve sonuçlarında nelerin değiştiğini gözlemlemektir. Materyal ve Metot: Primer küçük hücreli dışı akciğer kanseri (KHDAK) tanısı alan toplam 1071 hasta retrospektif olarak değerlendirildi. MK endikasyonu, 2003-2005 yılları arasında 610 KHDAK hastasının 454'üne (Grup 1), 2017-2019 yılları arasında 461 KHDAK hastasından 261'ine (Grup 2) kondu. Çalışmadan çıkarılan hastalar sonrasında, Grup 1'de 195 hasta ve Grup 2'de 194 hasta ameliyat edildi. MK endikasyonları, MK ile klinik multiple N2, N3, tek istasyon klinik N2 tespiti, beklenmedik patolojik (p) N2 oranları ve MK'nin yanlış negatifliği açısından iki grup karşılaştırıldı. Bulgular: Grup 1'de 610 hastanın 454'üne (% 74,4), Grup 2'deki 461 hastanın 261'ine (% 56,6) MK endikasyonu kondu (p <0.001). Grup 1'de 78 hastada (% 17,2) MK ile multipl klinik N2 ve N3 tanısı konulurken, Grup 2'de 4 hastaya (% 1,5) bu tanı kondu (p <0,001). Grup 1'de 18 hastada (% 4), Grup 2'de 27 hastada (% 10,3) klinik tek istasyon N2 tespit edildi (p = 0.001). Grup 1'de 45 hastada (% 23,1) beklenmeyen pN2 bulunurken, Grup 2'de 18 hastada (% 9,3) bulundu (p <0.001). Grup 1'de 17 hastada (% 8,7) yalancı negatiflik bulunurken, Grup 2'de ise 8 hastada (% 4,1) yanlış negatiflik bulundu (0.065). MK endikasyonları, multiple N2, N3, tek istasyon klinik N2 tanısı ve beklenmedik pN2 saptanması açısından gruplar arasında istatistiksel olarak anlamlı fark bulundu. Sonuç: Yıllar içinde, teknolojideki ve minimal invaziv tekniklerdeki gelişmeler sonucunda, servikal mediastinoskopi endikasyonları, MK ile klinik multiple N2, N3 hastalık tespiti, cerrahide beklenmedik pN2 tespiti ve MK'nin yanlış negatiflik oranları azalmıştır.

Keywords

• Servikal Mediastinoskopi
• yanlış negatiflik
• mediastinal evreleme
• beklenmeyen N2

What has changed in the indications and outcomes of cervical mediastinoscopy for mediastinal staging in non small cell lung cancer over the years?

Abstract

Objective: The aim of this study is to observe what has changed in the indications and outcomes of cervical mediastinoscopy (CM) as a result of advancements in the technology and diagnostic methods over the years. Materials and Methods: A total of 1071 patients, diagnosed with primary non small cell lung cancer (NSCLC) were evaluated retrospectively. CM was indicated in 454 patients (Group 1) out of 610 NSCLC patients between years 2003-2005, whereas 261 patients (Group 2) out of 461 NSCLC patients between years 2017-2019. After exclusions, 195 patients in Group 1 and 194 patients in Group 2 underwent surgery. We compared two groups in terms of CM indications, detection of clinic multiple N2, N3 and single-station cN2 disease with CM, unexpected pathologic (p)N2 ratios and false negativity of CM. Results: There were 454 of 610 patients (74.4%) in Group 1 and 261 of 461 patients (56.6%) in Group 2 were indicated with CM (p<0.001). While 78 patients (17.2%) in Group 1 were diagnosed with multiple clinics N2, N3 with CM, 4 patients (1.5%) in Group 2 (p <0.001). Single-station cN2 was detected in 18 patients (4%) in Group 1 and 27 patients (10.3%) in Group 2 (p = 0.001). While 45 patients (23.1%) had unexpected pN2 in Group 1, it was found in 18 patients (9.3%) in Group 2 (p <0.001). False negativity found in 17 patients (8.7%) in Group 1, whereas 8 patients (4.1%) in Group 2 (0.065). A statistically significant difference was found between the groups in terms of CM indications, diagnosis of clinic multiple N2, cN3, single-station cN2 and detection of unexpected pN2. Conclusion: Over the years, as a result of advancements in technology and minimally invasive techniques, cervical mediastinoscopy indications, clinical multiple N2, cN3 disease detection with CM, unexpected pN2 detection in surgery and false negativity ratios of CM have decreased.

Keywords

• Cervical Mediastinoscopy
• false negativity
• mediastinal staging
• unexpected N2

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