staging lymph node metastases from lung cancer in the mediastinum
DESCRIPTION
Staging lymph node metastases from lung cancer in the mediastinum. Linyao Thoracic surgery,unit one. Background. Lung cancer: 18% of all cancer death Staging: TNM classification system based in 1958 T:tumor size N:nodal disease M:metastasis. - PowerPoint PPT PresentationTRANSCRIPT
LinyaoThoracic surgery,unit one
Background
Lung cancer: 18% of all cancer death
Staging: TNM classification system based in 1958T:tumor sizeN:nodal diseaseM:metastasis
Current classification of the “N” component
N0: no lymph node metastasis N1: local peribronchial and/or ipsilateral
hilar
N2: ipsilateral mediastinal and/or subcarinal
N3:contralateral mediastinal and/or supraclavicular
evaluating N2 disease Imaging modalities
CT
PET
evaluating N2 disease Mediastinoscopy:“gold standard”
Lymph nodes stations 1, 2R, 2L, 3, 4R, 4L, and anterior station 7
morbidity 2%
mortality 0.08%
evaluating N2 disease ---invasive modalitiesEndobronchial ultrasound(EBUS)endoscopic ultrasound guided(EUS)
EBUS EUS
sensitivity 89% 89%
specificity 91% 100%
shortage both require high levels of expertise
evaluating N2 disease ---Intra-operative tchniquese
Lymph node dissection VS sampling
Debate:small sampling of relevant lymph nodes ?complete dissection of all visible lymph nodes ?
Conclusion: no difference
Moving towards molecular staging At present , use only T component
molecular staging with N componentCurrently unsuccessful
Advancing step: detect tumor DNA in N1 and N2 rather than intact cells
Prospect: more potent molecular marker technology
Sentinel lymph node staging Rely on lymphatic flow drainage patterns
Unsuccessful:large variability in lymphatic drainage among patients----“skipped metastases”
Conclusions Lung cancer :high morbidity and
mortality
Staging :TNM system(gold standard)
N2 disease:very heterogeneous require multiple investigating modalities
Prospects
Provide better prognostic value
Optimize treatment
Lead to fewer death
Thank you!