Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus

Abstract

In the staging of operable carcinoma of the bronchus, accurateassessment of mediastinal nodal status is essential in order to determinethe feasibility and desirability of resection. In the UK, frozen sectionanalysis is often logistically difficult, and many surgeons rely uponnaked-eye assessment. To evaluate the accuracy of this approach, we havereviewed 100 thoracotomies performed for cancer in this unit and comparedthe naked-eye assessment of nodal staging with the ultimate histologicalfindings. A total of 287 lymph nodes were examined. There were 14 falsepositives and 10 false negatives. The overall accuracy of naked-eyeassessment was 96.1%. On no occasion did an error in naked-eye assessmentresult in a patient receiving inappropriate treatment. All patients werethought to be pTNM N0 or N1 prior to surgery, yet N2 disease wasestablished in 24 patients. The value of routine mediastinal nodedissection at the time of thoracotomy has been established and an importantsubgroup of patients with microscopic N2 disease has been identified.