Prospective comparison of CT versus mediastinoscopy in preoperative evaluation of mediastinal lymph node status in patients with non-small cell lung cancer

Objective To compare the value of CT and mediastinoseopy in assessment of mediastinal lymph node status in potentially operable non-small cell lung cancer （NSCLC）. Methods From Oct. 2000 to Jun. 2007, 152 consecutive patients with pathologically proven and stage Ⅰ-Ⅲ NSCLC were enrolled into the study. Of the 152 cases, there were 118 males and 34 females, with a median age of 58 years （range, 24-79 years）. Compared with the final pathology, the sensitivity, specificity, positive and negative predictive values and accuracy of CT and mediastinoscopy for preoperative evaluation of mediastinal lymph node status were calculated, respectively. The accuracy and diagnostic efficacy of CT and mediastinoscopy was compared by Pearson X^2 test and ROC curve, respectively. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detection of mediastinal metastasis was 73.8% , 70.1% , 64.9% , 78.2% and 71.7% by CT, respectively, versus 83.1% , 100.0% , 100.0% , 88.8% and 92.8% by mediastinoscopy, respectively. Both the accuracy and diagnostic efficacy of mediastinoscopy were superior to CT （ Pearson X^2 test, P〈0.001 ; Z test of the areas under the ROC curve,P 〈0.001 ）. The complication rate of mediastinoseopy was 4.6%, and the false negative rate was 7.2%. Conclusion Mediastinoscopy is safe and effective in preoperative assessment of mediastinal lymph node status in potentially operable NSCLC, while CT alone is inadequate. Key words: CT;  Mediastinoscopy;  Non-small ceil lung cancer ;  Mediastinum;  Lymph nodes