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J Thorac Cardiovasc Surg 2007;133:276-277
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Robert J. Cerfolio, MD

Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL

The first 20% of the full text of this article appears below.

Dr Cesario and colleagues have posed some important and interesting questions concerning the role of repeat mediastinoscopy after induction radiotherapy. We need to limit our comments to patients who have had radiotherapy because that is the real issue and not those who had chemotherapy alone. The authors state that "pathologic reassessment of the mediastinum is strongly advisable," and we, as our article clearly outlines, agree. The table the authors show compares a clinical staging modality, positron emission tomography (PET)/computed tomography with a pathologic staging procedure (repeat mediastinoscopy). As we have preached and written, pathologic staging always trumps clinical staging,1Go and thus this comparison is unjustified. Repeat PET/computed tomography directs biopsies by providing targets for biopsy, as we clearly state. The question is as follows: What is the safest and most accurate way to achieve rebiopsy of previously cancerous N2 mediastinal lymph nodes after induction chemoradiotherapy? Although there is little doubt that repeat mediastinoscopy can be performed safely (as we have done several times ourselves), we do not recommend it on a national basis nor . . . [Full Text of this Article]


Related Article

Restaging patients with N2 (stage IIIa) non–small cell lung cancer after neoadjuvant chemoradiotherapy: A closer look at redo mediastinoscopy
Pierluigi Granone, Paul Van Schil, and Alfredo Cesario
J. Thorac. Cardiovasc. Surg. 2007 133: 275-276. [Extract] [Full Text] [PDF]





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