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Staging lymph node metastases from lung cancer in the mediastinum

Staging lymph node metastases from lung cancer in the mediastinum. Linyao Thoracic surgery,unit one. Background. Lung cancer: 18% of all cancer death Staging: TNM classification system based in 1958 T:tumor size N:nodal disease M:metastasis.

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Staging lymph node metastases from lung cancer in the mediastinum

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  1. Staging lymph node metastases from lung cancer in the mediastinum Linyao Thoracic surgery,unit one

  2. Background • Lung cancer: 18% of all cancer death Staging: TNM classification system • based in 1958 • T:tumor size • N:nodal disease • M:metastasis

  3. Current classification of the “N” component • N0: no lymph node metastasis N1: local peribronchial and/or ipsilateral hilar N2: ipsilateral mediastinal and/or subcarinal • N3:contralateral mediastinal and/or supraclavicular

  4. evaluating N2 disease • Imaging modalities • CT • PET

  5. evaluating N2 disease • Mediastinoscopy:“gold standard”

  6. evaluating N2 disease ---invasive modalities Endobronchial ultrasound(EBUS) endoscopic ultrasound guided(EUS)

  7. evaluating N2 disease ---Intra-operative tchniquese Lymph node dissection VS sampling Debate: small sampling of relevant lymph nodes ? complete dissection of all visible lymph nodes ? Conclusion: no difference

  8. Moving towards molecular staging • At present , use only T component

  9. molecular staging with N component • Currently unsuccessful • Advancing step: detect tumor DNA in N1 and N2 rather than intact cells Prospect: more potent molecular marker technology

  10. Sentinel lymph node staging • Rely on lymphatic flow drainage patterns • Unsuccessful: • large variability in lymphatic • drainage among patients---- • “skipped metastases”

  11. Conclusions Lung cancer :high morbidity and mortality • Staging :TNM system(gold standard) • N2 disease:very heterogeneous require multiple investigating modalities

  12. Prospects Provide better prognostic value Optimize treatment Lead to fewer death

  13. Thank you! Thank you!

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