Invasive staging of XXXX --a prospective study.

@entity1 @entity5 @entity1149 @entity2 @entity3
OBJECTIVES: Clinical prognosis and treatment schedules of @entity1149 ( @entity1149 ) are dependent on @entity5 stage. This explains the importance of an exact pretreatment staging of the primary @entity5 and lymph nodes especially in locally advanced @entity1149 , to differentiate between resectable and non-resectable disease. To assess the lymph node status of the upper mediastinum, the diagnostic value of mediastinoscopy is accepted to be superior to radiological methods. In contrast, thoracoscopy is not yet established as a standard staging tool. @entity1 AND METHODS: Seventy-three consecutive @entity1 with CT-based suspicion of advanced @entity1149 have been investigated as part of a phase II study on neoadjuvant treatment of @entity1149 . All @entity1 underwent mediastinoscopy and mediastinal lymph node sampling. In the case of a negative result we performed additional thoracoscopy. RESULTS: In 52.1% (n = 38) of the @entity1 the invasive diagnostic methods led to results that were effectively different from those of the radiological findings. In 11 @entity1 (15.1%) CT-assessed lymph node @entity3 could invasively not be confirmed, whereas nine @entity1 (12.3%) had positive mediastinal lymph nodes but no corresponding CT signs (diameter <1 cm). The results were achieved by mediastinoscopy in 15 (20.5%) and by thoracoscopy in five (6.8.%) @entity1 . A radiologically unexpected T4 stage has been found in four (5.5%) and a M1 stage in four (5.5%) @entity1 by thoracoscopy. On the contrary, in seven @entity1 a suspected infiltration of mediastinum or parietal pleura could be thoracoscopically excluded. Four @entity1 have been in an unexpected high stage of @entity5 progression at the moment of diagnostic procedures and therefore have been included in palliative therapy schedules. Ten @entity1 have been 'overstaged' by radiological methods and benefited from a primarily curative resection after invasive staging. CONCLUSIONS: Of the 73 prospectively studied @entity1 with locally advanced @entity1149 , 12 (16.4%) have been staged too low and 13 (17.8%) too high. If exclusively staged by radiological methods, about 34% of @entity2 have been classified incorrectly. Therefore, these tools are not a sufficient basis for diagnosis of @entity5 . Mediastinoscopy with consecutive thoracoscopy is an essential part of the therapeutic planning in locally advanced @entity1149 , and results are significantly superior to clinical staging.
