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Is the mediastinoscopy necessary when there is no distant metastatic disease?

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Posted on Wed, 9 Jul 2014
Question: I have some new questions to report. it has to be with oncologist such as Dr De. I go into surgery July 1. also if you can answer my latest questions. in the last few hours will be a start. I need to let you know for my next procedures

I have sent you the pet scan info and then from that the thoracic surgeon will do his procedure 1) bronchoscopy. 2)mediastinoscopy 3) lung surgery. Is the mediastinoscopy necessary when the pet scan said there was no evidence of distant metastatic disease.
doctor
Answered by Dr. Monish De (34 minutes later)
Brief Answer:
medianstinoscopy necessary

Detailed Answer:
Hi
XXXX
A medianstinoscopy is a procedure in which a tube a mediastinoscope is inserted through the chest wall to examine the area between the lungs (the mediastinum). The mediastinum contains the heart, the esophagus, the trachea, lymph nodes, and blood vessels. During this procedure doctors are able to look for tumors or enlarged lymph nodes, and take samples (biopsies) to look for cancer or other conditions.
A mediastinoscopy is recommended most often as a method to help determine the stage of lung cancer to see if, how far, and to what regions a cancer may have spread. An accurate understanding of the stage of a lung cancer is very important in helping doctors recommend the best options for treatment.
Though PET scan is showing no evidence of distant metastases PET CT scan sometimes can falsely be positive in inflammatory processes and falsely be negative in lung tumours with low metabolic activity such as bronchioloalveolar carcinoma or carcinoid tumours.
So in my view since the presence of mediastinal nodal metastases is a key factor in determining tumour resectability, lymph node sampling by mediastinoscopy is recommended.

Hope i have answered your query
Regards
DR De



Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Monish De (8 hours later)
I want to thank Dr. De for his response. we are nearing the end of my questions. I am going to e-mail the Pet scan for Dr De to review. with the little I know in trying to understand the info, I would like his opinion as I cannot get the pictures: 1)the info on the scan appears to not have gone to any vital organs . what do you feel. 2) I have been told by my regular doctor that this was caught early. what do you think? with the described procedure in my last question you seem to agree to the procedure that is going to be done. even though PET scan gives the reading, it is only precautionary to check everything as I understand it. if I am lucky enough that the PET scan is correct, do I have a good chance to rid the tumor with surgery and have a few years left . again , I want to thank Dr. De for his input with the opinion.
doctor
Answered by Dr. Monish De (28 minutes later)
Brief Answer:
Early stage of disease

Detailed Answer:
Hi

Medianstinoscopy is only being done as a precautionary measure to confirm the findings of PET CT as sometimes PET CT scan gives false positive results and the presence of mediastinal nodal metastases is a key factor in determining tumour resectability.

In my opinion you have caught the disease early and since you do not have distant metastases and as all your vital organs are working properly u do not need to worry as surgery causes cure rates of 60% to 80% and 5 year survival rates as high as 50%.

Hope I have answered your query.
If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health.

Regards
DR De
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Monish De

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Practicing since :2004

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Is the mediastinoscopy necessary when there is no distant metastatic disease?

Brief Answer: medianstinoscopy necessary Detailed Answer: Hi XXXX A medianstinoscopy is a procedure in which a tube a mediastinoscope is inserted through the chest wall to examine the area between the lungs (the mediastinum). The mediastinum contains the heart, the esophagus, the trachea, lymph nodes, and blood vessels. During this procedure doctors are able to look for tumors or enlarged lymph nodes, and take samples (biopsies) to look for cancer or other conditions. A mediastinoscopy is recommended most often as a method to help determine the stage of lung cancer to see if, how far, and to what regions a cancer may have spread. An accurate understanding of the stage of a lung cancer is very important in helping doctors recommend the best options for treatment. Though PET scan is showing no evidence of distant metastases PET CT scan sometimes can falsely be positive in inflammatory processes and falsely be negative in lung tumours with low metabolic activity such as bronchioloalveolar carcinoma or carcinoid tumours. So in my view since the presence of mediastinal nodal metastases is a key factor in determining tumour resectability, lymph node sampling by mediastinoscopy is recommended. Hope i have answered your query Regards DR De