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Mediyastinoskopi yapılmayan 21 akciğer kanserli olguda N2 pozitifliğinin araştırılması

The analysis of N2 positivity in 21 cases with lung cancer not evaluated with mediastinoscopy

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2008

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Abstract (2. Language): 
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.
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Abstract (Original Language): 
Bu çalışmadaki amacımız radyolojik evreleme dikkate alınarak cerrahi tedavi uygulanan hastalarda N2 pozitifliği oranını saptamak, literatür bilgileri ışığında mediyastinal lenf nodu evrelemesinin çeşitli yönlerini tartışmak ve bir algoritm ortaya koymaya çalışmaktır. Kliniğimizde 2005 ile 2006 yılları arasında klinik olarak N2 negatif düşünülerek cerrahi tedavi uygulanan primer akciğer kanserli 21 olgu yaş, cinsiyet, tanı ve evreleme yöntemleri, klinik evre, patolojik evre, histopatolojik tip, uygulanan cerrahi tedavi ve mediyastinal lenf nodu örneklemesi yöntemleri açısından retrospektif olarak incelenmiştir. Olguların 19'u erkek 2'si kadın ve yaş ortalaması 62.3 (21-70) yıl olarak saptanmıştır. Histopatolojik tip olarak 11 olguda adenokarsinom, 7 olguda yassı epitel hücreli karsinom, iki olguda adenoskuamöz karsinom ve bir olguda da lenfoepitelyoma benzeri karsinom saptanmıştır. On beş olguya lobektomi, üç olguya bilobektomi, bir olguya pnömonektomi ve iki olguya solunum rezervlerinin kısıtlı olması nedeniyle "wedge" rezeksiyon uygulanmıştır. Mediyastinal evreleme için 11 olguda sadece toraks tomografisi kullanılırken, 10 olguda toraks tomografisi ve pozitron emisyon tomografisi tetkikleri kullanılmıştır. Klinik olarak olguların 10'u IA ve 11'i IB olarak evrelenmiştir. Patolojik evrelemede 6 olguda (%29) N2 pozitifliği saptanmıştır. N2 pozitif saptanan olgulardan 5'inin adenokarsinom ve birinin yassı epitel hücreli karsinom olduğu saptanmıştır. N2 pozitif olgulardan birine preoperatif dönemde pozitron emisyon tomografisi yapılmış ve radyoaktif madde tutulumu saptanmamıştır. Cerrahi rezeksiyon öncesi doğru mediyastinal evreleme yapılmalıdır çünkü bir kaç özel durum dışında N2 pozitif olan olgularda uygulanacak cerrahi tedavi, surviye katkı sağlamayacağı gibi cerrahinin yol açacağı morbiditeler göz önüne alındığında olumsuz etkileri olabilir. Non-invaziv ve invaziv evreleme yöntemlerinin bir algoritm dahilinde uygulanması, N2 pozitifliğini daha doğru değerlendirmemizi sağlayacak ve gereksiz torakotomilerin oranını azaltacaktır.
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