27. Prospective Paired Comparison of Radiologic, Thoracoscopic, and Pathological Staging in Patients with Lung Cancer and Negative Mediastinal Nodes

John R. Roberts, Anne Bradley, Matthew Blum, Karla Richey, Walter Merrill, Davis Drinkwater, Robin Pierson

Vanderbilt University Medical Center

Nashville, Tenn.

Background: Neoadjuvant chemotherapy improves survival of stage IIIA lung cancer and may be used to treat earlier stage (IB, IIA, and IIB) lung cancer in the future. CT scanning inaccurately stages mediastinal nodes, but is used to stage local extent of lung cancer. We compared radiologic, thoracoscopic, and pathologic staging in thirty patients with negative mediastinal nodes to evaluate relative accuracy in staging earlier lung cancer.

Methods: Thirty patients with negative mediastinoscopy underwent CT scanning and thoracoscopic staging prior to surgical resection. The results of CT and thoracoscopic staging were compared to pathologic results after resection.

Results: Twenty of thirty patients were inaccurately staged by CT scanning, while three of 30 patients were understaged by thoracoscopy. Ten patients were understaged by CT (two of whom had unexpected malignant pleural effusions), while ten were overstaged. Two other patients had positive pleural lavage.