Diagnostic value of mediastinoscopic biopsy on R4 lymph-node in patients with lung cancer

Abstract

7335 Background: Diagnosis of malignant cells in mediastinum lymphnode is important for staging procedures and resulting therapeutic decisions. The aim of this study was to evaluate the application of mediastinoscopic biopsy on right lower trachea-bronchial (R4) lymph-node in diagnosis and pathologic staging on lung cancer. Methods: Sixty-six patients with lung cancer including 47 cases of right lung cancer and 19 cases of left lung cancer received mediastinoscopic biopsy on R4 lymph-node from November 1999 to May 2004. The preoperative diagnosed and suspected lung cancers were 17 and 49 cases, respectively. The operation included cervical mediastinalscopy in 62 cases, parasternal mediastinalscopy in 1 case and cervical combined with parasternal mediastinalscopy in 3 cases. Results: In total 66 patients, Tumor metastases in R4 lymph-node were found in 49 cases. 38 out of 47 patients with right lung cancer and 11 out of 19 patients with left lung cancer were found tumor metastasis in R4 lymph-node. The metastasis rate in small cell lung cancer, adenocarcinoma and squamous cell carcinoma were 100%, 82.2% and 52%, respectively. For diagnosis of the 49 preoperatively suspected lung cancer patients, malignant tumor was confirmed by mediastinoscopic biopsy or open thoracic surgery in 40 and 9 cases respectively. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusions: R4 lymph-node is one of the most common and important site for the tumor metastasis in lung cancer. Mediastinoscopic biopsy on R4 lymph-node has incomparable advantages in diagnosis and staging on lung cancer over other examinations and biopsy on other lymph-nodes. No significant financial relationships to disclose.