ABSTRACT

The aims of this study were to investigate the rate of N2 positivity in patients treated surgically on the basis of radiological staging, to discuss the various aspects of mediastinal lymph node staging in the light of literature knowledge and to try to constitute an algorithm. Twenty one patients with primary lung cancer who were treated surgically assuming N2 negative clinically at our clinic between 2005 and 2006 were reviewed retrospectively with respect to age, gender, methods of diagnosis and staging, clinical stage, pathological stage, histopathological type, surgical treatment performed and the methods of mediastinal lymph node sampling. Nineteen and 2 of the patients were male and female, respectively, and their mean age was 62.3 (21- 70) years. Histopathological types were adenocarcinoma in 11 cases, squamouse cell carcinoma in 7 cases, adenosquamose carcinoma in 2 cases and lymphoepithelioma like carcinoma in 1 case. A lobectomy was performed in 15 patients, bilobectomy in 3 patients, pneumonectomy in 1 patient and wedge resection because of low respiratuar capacity in 2 patients. A computed tomography of the chest only was used in 11 patients, whereas both computed tomography of the chest and positron emission tomography were used in the other 10 patients for mediastinal staging. Clinically 10 and 11 of the patients were staged as IA and IB, respectively. In pathologic staging, the N2 positivity was found in 6 patients (29%). Out of these 6 patients, the histopathological type was adenocarcinoma in 5 patients and squamouse cell carcinoma in 1 patient. Positron emission tomography scanning was performed preoperatively to one of 6 patients with N2 positivity and no activity was observed. A correct mediastinal staging should be performed before a surgical resection because surgical treatment in N2 positive cases not only contributes to survey but also may have adverse effects considering the probable morbidities caused by the surgery itself. Carrying out the invasive and non-invasive staging methods according to an algorithm will allow us to evaluate the N2 positivity more correctly and decrease the rate of unnecessary thoracotomies.