Lymph-node-staging in patients with non-small-cellular bronchial carcinoma. Is mediastinoscopy justified in times of 18-FDG PET?
Project management at the University of Würzburg:
In Germany, more than 45000 patients per year die due to a bronchial carcinoma. Histologically, the non-small-cellular (about 75-80%; NSCLC) is distinguished from the small-cellular bronchial-carcinoma (SCLC). The prognosis of bronchial-carcinoma correlates not only with the histopathological type, but also with tumor stage. Stage classification is performed based on the TNM-classification.
The affection of mediastinal lymph-nodes is the most important factor in the diagnosis of the NSCLC. Moreover, for realistic assessment of the individual prognosis an exact tumor stage is of great importance. Due to the inhomogeneous composition of (especially) stage 3, different strategies for therapy exist today, dependent on the definite tumor stage. However, there are still deficits in pre-operative diagnosis and stage classification, mostly due to the problem that affected lymph-nodes would only be visible in the CT-thoracic investigation if they are bigger than approximately 1cm. Even questionably enlarged lymph-nodes do not have to be malignant.
On the one hand, with mediastinoscopy not all lymph-nodes in the mediastinum can be reached, on the other, there is the risk that biopsies are not removed from the affected lymph-nodes or that the biopsy from the lymph-node is not from the malignant part.
In this regard, the positron-emission-tomography might serve as the decisive aid. The radioactive tracer is not only concentrated in biologically active lymph-node structures (independent of their size), but the thoracic surgeon is also provided with a topographical aid for mediastinoscopy..
Aim of the study is, on the one hand, to demonstrate the relevance of positron-emission-tomography for the diagnosis of bronchial carcinomas and on the other hand, to compare the 18-FDG-PET investigation with mediastinoscopy. In case, the positron-emission-tomography reveals comparable sensitivity and specificity, the more dangerous and expensive mediastinoscopy could be avoided for diagnosis of tumor stage 3a or 3b in patients with histologically proven NSCLC in the near future.
Projekt period: since 05.2000