The Role of Transcarinal Needle Aspiration in the Stagingof BronchogenicCarcinoma

ccurate staging ofbronchogenic carcinoma is important in determining resectability. Metastasis of tumor to the subcarinal nodes is generally believed to indicate unresectability because of the extremely poor prognosis with surgical resection when these nodes are ‘� It would be best to spare patients with subearinal nodal involvement the morbidity, mortality, and expense of surgical staging, but current nonsurgical methods of detecting tumor in the subearinal nodes are not sufficiently reliable. The chest roentgenogram may be misleading,5 and computed tomography of the thorax has a significant false-positive rate.67 Imaging studies can detect enlargement of nodes, but cannot distinguish between inflammatory or neoplastic causes ofenlargement. Histologic confirmation oftumor is mandatory before a decision is made concerning the unresectability of bronchogenic carcinoma. Mediastinoscopy is currently the least invasive surgical approach to obtain tissue for a histologic diagnosis of lymphatic spread of lung cancer, but the subcarinal nodes are difficult to assess by this technique,8 and false-negative mediastinoscopic results are frequently due to tumor in the pretracheal and subcarinal nodes.89 Patients with disease confined to this group ofnodes may be found to have unresectable carcinoma during thoracotomy rather than during the less invasive procedure of mediastinoscopy.