Peripheral small-sized (2 cm or less) XXXX with mediastinal lymph node @entity3 ; clinicopathologic features and patterns of nodal spread.

@entity1 @entity1313 @entity5 @entity1149 @entity2 @entity3 @entity420
OBJECTIVE: The diagnosis of small-sized (2 cm or less) @entity1149 ( @entity1149 ) has increased with the development of computed tomography (CT), whereas unexpected extensive multiple-level mediastinal involvement has been occasionally detected in this small-sized @entity2 . To establish the optimal surgical strategy, we retrospectively analyzed the clinicopathologic features, efficacy of preoperative investigations and lobe specific patterns of nodal spread in small-sized @entity1149 with mediastinal involvement. METHODS: Among 1,550 resected @entity2 cases between 1981 and 2000, 267 (17.2%) had peripheral small-sized @entity1149 . Of these, 29 @entity1 (10.8%) with mediastinal lymph node involvement who underwent pulmonary resection and systematic nodal dissection were reviewed. RESULTS: Among 29 @entity1 , 27 @entity1 (93.1%) were @entity420 , and 51.7% (15/29) showed no lymph node enlargement on CT (cN0). Surgical pathology revealed multiple-level mediastinal involvement in 65.5% (19/29) of all @entity1 and 60.0% (9/15) of cN0 @entity1 . All of @entity1313 (n=11) showed multiple-level involvement. Thallium-201 single photon emission computed tomography (201Tl-SPECT) was positive for increased focal uptake in the mediastinum in 72.7% (8/11) of @entity1 . CONCLUSIONS: The vast majority of cases were @entity420 , and two thirds of them showed multiple-level mediastinal involvement, even in cN0 @entity1 . We thus recommend to perform systematic nodal dissection or meticulous sampling for accurate intrathoracic @entity5 , especially for @entity1313 . 201Tl-SPECT appears to be more sensitive preoperative investigation for mediastinal @entity3 compared with CT scan.
