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Eur J Cardiothorac Surg 2001;20:335-338
© 2001 Elsevier Science NL

Improved pre-operative mediastinal staging in non-small-cell lung cancer by serial sectioning and immunohistochemical staining of lymph-node biopsies

^a Department of Surgery, Atrium Medical Centre (Atrium Medisch Centrum), 6401 CX Heerlen, The Netherlands
^b Department of Pathology, Atrium Medical Centre (Atrium Medisch Centrum), 6401 CX Heerlen, The Netherlands

Received 21 November 2000; received in revised form 23 April 2001; accepted 1 May 2001.

Corresponding author. Tel.: +31-384247058; fax: +31-384542040
e-mail: j.oosterhuis{at}tip.nl

Objective: Mediastinal staging of non-small-cell lung carcinoma (NSCLC) by mediastinoscopy suffers from a low sensitivity, leading to a number of patients with unforeseen N2 disease at thoracotomy. This study was undertaken to assess whether pre-operative staging could be improved by serial sectioning and immunohistochemical staining of mediastinoscopy biopsies. Methods: In 183 consecutive patients with NSCLC, a thoracotomy was performed after a thorough mediastinal staging by computed tomography scan and cervical mediastinoscopy. In 158 patients (88%), a mediastinal node dissection was performed, revealing unforeseen N2 disease in 24 cases (15%). The preserved mediastinoscopy biopsies of these patients were retrospectively serially sectioned and stained with MNF 116. Results: Metastases could be identified in seven cases (30%), reducing unforeseen N2 disease from 15 to 10%. The number of patients who could theoretically benefit from neo-adjuvant therapy would have been increased by at least 10%. Conclusions: Pre-operative mediastinal staging can be improved considerably by serial sectioning and immunohistochemical staining of mediastinoscopic biopsy specimens.

Key Words: Lung neoplasms • Lymphatic metastases • Mediastinum • Mediastinoscopy • Neoplasm staging • Immunohistochemistry

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