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REVIEW
Mediastinal Staging in Lung Cancer. The quest for a cost-effective strategy
Vasileios S. Skouras 1,2
,
 
Nicholas J. Pastis 1
,
 
Vlasis Polychronopoulos 3
,
 
Gerard A. Silvestri 1
 
 
 
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1
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
 
2
Department of Pulmonary Medicine, 401 General Army Hospital, Athens, Greece
 
3
Department of Pulmonary Medicine, “Hygeia” General Hospital, Athens, Greece
 
 
Corresponding author
Vasileios S. Skouras   

Department of Pulmonary and Sleep Medicine 401 General Army Hospital 1 Kanellopoulou Street, 11526, Athens, Greece
 
 
Pneumon 2014;27(1):52-67
 
Article (PDF)
References (99)
 
KEYWORDS
lung cancer
mediastinum
staging
cost-effectiveness
probability analysis
 
ABSTRACT
Lung cancer is the most lethal cancer worldwide. The most favourable prognosis is achieved with complete resection of the malignant tumour, which is only feasible in the absence of both distant metastases and mediastinal involvement. The suitability for surgery in patients without metastases is therefore determined by accurate mediastinal staging. The methods available for this purpose include imaging and invasive techniques, but as no single method is sufficiently accurate at ruling in and ruling out mediastinal involvement in lung cancer a strategy based on the sequential use of staging methods is required. The cost-effectiveness of such a strategy depends on the sequence of the methods chosen and the requirement for further confirmation of the results of each method. The management of positive results derived from the various staging methods is well documented, but not the management of negative results, for which the current literature is not conclusive. The estimation by probability analysis of negative post-test probabilities following the use of the various methods can assist in the management of negative results and also provides guidance for future research related to the design of the most cost-effective strategy for staging mediastinal involvement in lung cancer.
ABBREVIATIONS
ACCP: American College of Chest Physicians, AJCC: American Joint Committee on Cancer, APW: aortopulmonary window, CT: computed tomography, DW-MRI: diffusion-weighted MRI, EBUS-TBNA: endobronchial ultrasound TBNA, EUS-NA: endoscopic ultrasound needle aspiration, IASLC: International Association for the Study of Lung Cancer, MLN: mediastinal lymph node, MRI: magnetic resonance imaging, n-PTP: negative post-test probability, p-PTP: positive post-test probability, PET: positron-emission tomography, QALY: quality-adjusted life years, STIR-SE-MRI: short-inversion time, inversion recovery, turbo spin-echo MRI, SUVmax: maximum standard uptake value, SVC: superior vena cava, TBNA: transbronchial needle aspiration, VAM: video-assisted mediastinoscopy, VATS: video-assisted thoracoscopy
FUNDING
There was no funding for the present study .
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