Skip to main content
Erschienen in: General Thoracic and Cardiovascular Surgery 7/2020

07.04.2020 | Special Edition

Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling?

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Lymph node assessment is an essential component of the treatment of lung cancer. Identification of the correct “N” stage is important for staging which in turn determines treatment. Assessment of lymph nodes may be accomplished using imaging with CT scan and PET–CT, invasive techniques such as mediastinoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasound fine needle aspiration (EUS-FNA). Ultimately, regardless of any pre-resection assessment, lymph nodes must be assessed at the time of resection. The question to be addressed in this report is the role of mediastinal lymph node dissection versus lymph node sampling. However, the issues surrounding lymph node assessment in NSCLC are complex, depending on clinical stage, imaging and histology.
Literatur
1.
Zurück zum Zitat Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest. 1959;36:343–52.PubMedCrossRef Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest. 1959;36:343–52.PubMedCrossRef
2.
Zurück zum Zitat Silvestri GA. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 suppl):e211s–e250s250s.PubMedCrossRef Silvestri GA. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 suppl):e211s–e250s250s.PubMedCrossRef
3.
Zurück zum Zitat Silvestri GA, Gould MK, Margolis ML, Tanoue LT, MCrory D, Toloza E, et al. Noninvasive staging of non-small cell lung cancer. ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):178S–201S.PubMedCrossRef Silvestri GA, Gould MK, Margolis ML, Tanoue LT, MCrory D, Toloza E, et al. Noninvasive staging of non-small cell lung cancer. ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):178S–201S.PubMedCrossRef
5.
Zurück zum Zitat Al-Sarraf N, Gately K, Lucey J, Wilson L, McGovern E, Young V. Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: analysis of 1145 lymph nodes. Lung Cancer. 2008;60(1):62–8.PubMedCrossRef Al-Sarraf N, Gately K, Lucey J, Wilson L, McGovern E, Young V. Lymph node staging by means of positron emission tomography is less accurate in non-small cell lung cancer patients with enlarged lymph nodes: analysis of 1145 lymph nodes. Lung Cancer. 2008;60(1):62–8.PubMedCrossRef
6.
Zurück zum Zitat Ghosh S, Nanjiah P, Dunning J. Should all patients with non-small cell lung cancer who are surgical candidates have cervical mediastinoscopy preoperatively? Interact Cardiovasc Thorac Surg. 2006;5(1):20–4.PubMedCrossRef Ghosh S, Nanjiah P, Dunning J. Should all patients with non-small cell lung cancer who are surgical candidates have cervical mediastinoscopy preoperatively? Interact Cardiovasc Thorac Surg. 2006;5(1):20–4.PubMedCrossRef
7.
Zurück zum Zitat Cerfolio RJ, Bryant AS, Eloubeidi MA. Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative: a prospective study. Chest. 2006;130(6):1791–5.PubMedCrossRef Cerfolio RJ, Bryant AS, Eloubeidi MA. Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative: a prospective study. Chest. 2006;130(6):1791–5.PubMedCrossRef
8.
Zurück zum Zitat Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thor Oncol. 2011;6:1367–72.CrossRef Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thor Oncol. 2011;6:1367–72.CrossRef
9.
Zurück zum Zitat Herth FJF, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887–91.PubMedCrossRef Herth FJF, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887–91.PubMedCrossRef
10.
Zurück zum Zitat Yasufuku K, Pierre A, Darling G, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142:1393–400.PubMedCrossRef Yasufuku K, Pierre A, Darling G, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142:1393–400.PubMedCrossRef
11.
Zurück zum Zitat Caddy G, Conron M, Wright G, et al. The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC. Eur Resp J. 2005;25:410–5.CrossRef Caddy G, Conron M, Wright G, et al. The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC. Eur Resp J. 2005;25:410–5.CrossRef
12.
Zurück zum Zitat Cahan G. Radical lobectomy. J Thorac Cardiovasc Surgery. 1960;39:555–72.CrossRef Cahan G. Radical lobectomy. J Thorac Cardiovasc Surgery. 1960;39:555–72.CrossRef
13.
Zurück zum Zitat Martini N. Mediastinal lymph node dissection for lung cancer. The Memorial experience. Chest Surg Clin N Am. 1995;5:189–203.PubMed Martini N. Mediastinal lymph node dissection for lung cancer. The Memorial experience. Chest Surg Clin N Am. 1995;5:189–203.PubMed
14.
Zurück zum Zitat Kuzdzal J, Warmus J, Grochowski Z. Optimal mediastinal staging in non-small cell lung cancer: What is the role of TEMLA and VAMLA. Lung Cancer. 2014;86:1–4.PubMedCrossRef Kuzdzal J, Warmus J, Grochowski Z. Optimal mediastinal staging in non-small cell lung cancer: What is the role of TEMLA and VAMLA. Lung Cancer. 2014;86:1–4.PubMedCrossRef
15.
Zurück zum Zitat Lardinois D, Suter H, Hakki H, et al. Morbidity, survival and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thor Surg. 2005;80:268–74.CrossRef Lardinois D, Suter H, Hakki H, et al. Morbidity, survival and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thor Surg. 2005;80:268–74.CrossRef
16.
Zurück zum Zitat Osarogiagbon RU, Decker PA, Ballman K, et al. Survival implications of variation in the thoroughness of pathologic lymph node examination in American college of surgeons oncology group Z0030 (Alliance). Ann Thor Surg. 2016;102:363–9.CrossRef Osarogiagbon RU, Decker PA, Ballman K, et al. Survival implications of variation in the thoroughness of pathologic lymph node examination in American college of surgeons oncology group Z0030 (Alliance). Ann Thor Surg. 2016;102:363–9.CrossRef
17.
Zurück zum Zitat Smeltzer MP, Faris N, Yu X, et al. Missed intrapulmonary lymph node metastasis and survival after resection of non-small cell lung cancer. Ann Thor Surg. 2016;102:448–53.CrossRef Smeltzer MP, Faris N, Yu X, et al. Missed intrapulmonary lymph node metastasis and survival after resection of non-small cell lung cancer. Ann Thor Surg. 2016;102:448–53.CrossRef
18.
Zurück zum Zitat Smeltzer MP, Faris NR, Ray MA, Osarogiagbon RU. Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent. JAMA Oncol. 2018;4:80–7.PubMedCrossRef Smeltzer MP, Faris NR, Ray MA, Osarogiagbon RU. Association of pathologic nodal staging quality with survival among patients with non-small cell lung cancer after resection with curative intent. JAMA Oncol. 2018;4:80–7.PubMedCrossRef
19.
Zurück zum Zitat Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg. 1998;227:138–44.PubMedPubMedCentralCrossRef Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg. 1998;227:138–44.PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Wu Y, Huang Z, Wang S, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer. 2002;35:1–6.CrossRef Wu Y, Huang Z, Wang S, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer. 2002;35:1–6.CrossRef
22.
Zurück zum Zitat Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIA non-small cell lung cancer. Ann Thor Surg. 2000;70:358–65.CrossRef Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIA non-small cell lung cancer. Ann Thor Surg. 2000;70:358–65.CrossRef
23.
Zurück zum Zitat Oda M, Watanabe Y, Shimizu J, et al. Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: The role of systematic nodal dissection. Lung Cancer. 1998;22:23–30.PubMedCrossRef Oda M, Watanabe Y, Shimizu J, et al. Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: The role of systematic nodal dissection. Lung Cancer. 1998;22:23–30.PubMedCrossRef
24.
Zurück zum Zitat Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patients with N0 or N1 ( less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.PubMedPubMedCentralCrossRef Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patients with N0 or N1 ( less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.PubMedPubMedCentralCrossRef
25.
Zurück zum Zitat Asamura H, Nakayama H, Kondo H, Tsuchiya R, Naruke T. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg. 1999;117:1102–11.PubMedCrossRef Asamura H, Nakayama H, Kondo H, Tsuchiya R, Naruke T. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg. 1999;117:1102–11.PubMedCrossRef
26.
Zurück zum Zitat Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg. 2006;81:1028–32.PubMedCrossRef Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg. 2006;81:1028–32.PubMedCrossRef
27.
Zurück zum Zitat Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg. 2010;139:1001–6. https://doi.org/10.1016/j.jtcvs.2009.07.024.PubMedCrossRef Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg. 2010;139:1001–6. https://​doi.​org/​10.​1016/​j.​jtcvs.​2009.​07.​024.PubMedCrossRef
28.
Zurück zum Zitat Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2013;44:e59–64.PubMedCrossRef Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg. 2013;44:e59–64.PubMedCrossRef
29.
Zurück zum Zitat Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small-cell lung cancer: A propensity score matching study. J Thorac Oncol. 2017;12:85–93.PubMedCrossRef Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small-cell lung cancer: A propensity score matching study. J Thorac Oncol. 2017;12:85–93.PubMedCrossRef
30.
Zurück zum Zitat Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage I and II NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol. 2016;11:1529–37.PubMedCrossRef Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage I and II NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol. 2016;11:1529–37.PubMedCrossRef
31.
Zurück zum Zitat Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg. 2017;51:674–9.PubMedPubMedCentralCrossRef Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage I lung cancer patients. Eur J Cardiothorac Surg. 2017;51:674–9.PubMedPubMedCentralCrossRef
32.
Zurück zum Zitat Meng D, Zhou Z, Wang Y, et al. Lymphadenectomy for clinical early-stage non-small–cell lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50:597–604.PubMedCrossRef Meng D, Zhou Z, Wang Y, et al. Lymphadenectomy for clinical early-stage non-small–cell lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50:597–604.PubMedCrossRef
33.
Zurück zum Zitat Hishida I, Saji H, Watanabe SI, et al. A randomized phase III trial of lobe-specific vs. systematic nodal dissection for clinical Stage I-II non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol. 2018;48:190–4.PubMedCrossRef Hishida I, Saji H, Watanabe SI, et al. A randomized phase III trial of lobe-specific vs. systematic nodal dissection for clinical Stage I-II non-small cell lung cancer (JCOG1413). Jpn J Clin Oncol. 2018;48:190–4.PubMedCrossRef
34.
Zurück zum Zitat Ramirez RA, Wang CG, Miller LE, et al. Incomplete intrapulmonary lymph node retrieval after routine pathologic examination for resected lung cancer. J Clin Oncol. 2012;30:2823–8.PubMedCrossRef Ramirez RA, Wang CG, Miller LE, et al. Incomplete intrapulmonary lymph node retrieval after routine pathologic examination for resected lung cancer. J Clin Oncol. 2012;30:2823–8.PubMedCrossRef
35.
Zurück zum Zitat Lardinois D, De Leyn P, Van Schil P, Porta RR, Waller D, Passlick B, Zielinski M, Lerut T, Weder W. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006;30(5):787–92.PubMedCrossRef Lardinois D, De Leyn P, Van Schil P, Porta RR, Waller D, Passlick B, Zielinski M, Lerut T, Weder W. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006;30(5):787–92.PubMedCrossRef
36.
Zurück zum Zitat Samayoa AX, Pezzi TA, Pezzi CM, et al. Rationale for a minimum number of lymph nodes removed with non-small cell lung cancer resection: correlating the number of nodes removed with survival in 98,970 patients. Ann Surg Oncol. 2016;23(suppl 5):1005–111.PubMedCrossRef Samayoa AX, Pezzi TA, Pezzi CM, et al. Rationale for a minimum number of lymph nodes removed with non-small cell lung cancer resection: correlating the number of nodes removed with survival in 98,970 patients. Ann Surg Oncol. 2016;23(suppl 5):1005–111.PubMedCrossRef
37.
Zurück zum Zitat Liang W, He J. Shen Y et al Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: a population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol. 2017;35:1162–70.PubMedCrossRef Liang W, He J. Shen Y et al Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: a population study of the US SEER database and a Chinese multi-institutional registry. J Clin Oncol. 2017;35:1162–70.PubMedCrossRef
38.
Zurück zum Zitat Noguchi M, Morikawa A, Kowasaki M, et al. Small adenocarcinoma of the lung histologic characteristics and prognosis. Cancer. 1995;75:2844–52.PubMedCrossRef Noguchi M, Morikawa A, Kowasaki M, et al. Small adenocarcinoma of the lung histologic characteristics and prognosis. Cancer. 1995;75:2844–52.PubMedCrossRef
39.
Zurück zum Zitat Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thor Oncol. 2015;10:1243–60.CrossRef Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thor Oncol. 2015;10:1243–60.CrossRef
40.
Zurück zum Zitat Yuan Y, Ma G, Zhang Y, Chen H. Presence of micropapillary and solid patterns are associated with nodal upstaging and unfavourable prognosis among patients with cT1N0M0 lung adenocarcinoma: a large scale analysis. J Cancer Res Clin Oncol. 2018;144:743–9.PubMedCrossRef Yuan Y, Ma G, Zhang Y, Chen H. Presence of micropapillary and solid patterns are associated with nodal upstaging and unfavourable prognosis among patients with cT1N0M0 lung adenocarcinoma: a large scale analysis. J Cancer Res Clin Oncol. 2018;144:743–9.PubMedCrossRef
41.
Zurück zum Zitat Nasir BS, Yasufuku K, Liberman M. When should negative endobronchial ultrasonography findings be confirmed by a more invasive procedure? Ann Surg Oncol. 2018;2:68–75.CrossRef Nasir BS, Yasufuku K, Liberman M. When should negative endobronchial ultrasonography findings be confirmed by a more invasive procedure? Ann Surg Oncol. 2018;2:68–75.CrossRef
Metadaten
Titel
Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling?
Publikationsdatum
07.04.2020
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 7/2020
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-020-01345-y

Weitere Artikel der Ausgabe 7/2020

General Thoracic and Cardiovascular Surgery 7/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.