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Mediastinoscopic Ultrasonography (MUS) as a Surgical Adjuvant in Lung Cancer Staging

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The Transcervical Approach in Thoracic Surgery

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Abstract

The pretherapeutic assessment of the mediastinal T-status of locally advanced lung carcinoma remains an unsolved problem, whereas mediastinal nodal staging can nowadays be performed with high accuracy. Limitations of non-invasive imaging (CT scan and MRI) favour overstaging of the T-category with the result being that patients receive palliative rather than curative intent therapy. On the other hand, principally presuming a lower stage in centrally located lung tumours inevitably results in an increased number of non-curative exploratory thoracotomies. In this dilemma a valid imaging procedure is clearly needed. Using the artificial pretracheal space created during staging mediastinoscopy in order to introduce sterilizable ultrasound probes, we developed mediastinoscopic ultrasonography (MUS) in an attempt to improve the assessment of the T-status of centrally located lung cancer. Among the ultrasound modalities that offer access to the mediastinum, transesophageal echography and MUS complement one another topographically with regard to mediastinal T-staging.

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Acknowledgments

The authors wish to thank Dr. Ricarda Lachmann, for the re-examination of the CT scans, as well as Dr. S. Herber, PhD, head of the department of radiology of our hospital, for allowing us to use the CT and MRI imaging used in this article. Furthermore, we would like to thank Mr. Alexander Zitzer for his valuable contribution in graphic design (Fig. 8.2) as well as Mr. Stefan Kup (IT department) for his help in the preparation of the videos.

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz, Rudolf-Virchow-Straße 7, Koblenz, 56073, Germany

    Michael Wolf MD, Biruta Witte MD & Martin Hürtgen MD, PhD

Authors
  1. Michael Wolf MD
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  2. Biruta Witte MD
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  3. Martin Hürtgen MD, PhD
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Correspondence to Michael Wolf MD .

Editor information

Editors and Affiliations

  1. Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland

    Marcin Zieliński

  2. Thoracic Surgery Service, University Hospital Mutua Terrassa, Terrassa, Spain

    Ramón Rami-Porta

1 Electronic Supplementary Material

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MUS radial probe: the intrapericardial left superior pulmonary vein in cross section near the level of the pericardial reflection. It shows free pulsatile movements. No intrapericardial tumour is seen. UVP = left superior pulmonary vein, Tr.pulm. = pulmonary trunk, r.PA. = right pulmonary artery, VCS = superior vena cava (MP4 437 KB)

CT scan (axial): lung carcinoma of the middle lobe growing centrally along the right superior pulmonary vein. The tumour encases the roof of the left atrium, where the right pulmonary vein drains into the atrial chamber (AVI 23086 kb) (MP4 98 MB)

Contrast-enhanced axial MRI: middle lobe tumour with suspected intrapericardial invasion of the right superior pulmonary vein (MP4 1.82 MB)

Contrast-enhanced sagittal MRI: middle lobe tumour with suspected intrapericardial invasion of the right superior pulmonary vein (MP4 1.31 MB)

Cine MRI (axial): middle lobe tumour growing centrally along the superior pulmonary vein, reaching the roof of the left atrium (MP4 835 KB)

Cine MRI (short heart axis): middle lobe tumour growing centrally along the superior pulmonary vein, reaching the roof of the left atrium (MP4 1.25 MB)

Video MUS convex probe: The superior pulmonary vein is invaded within the pericardial reflection, proven by the crescent-shaped pericardial fluid space seen at the left side of the vessel. Colour Doppler shows the filiform configuration of the invaded vessel. UPV = intrapericardial superior pulmonary vein, PERIC. = pericardial fluid, TU = tumour (MP4 584 KB)

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Wolf, M., Witte, B., Hürtgen, M. (2014). Mediastinoscopic Ultrasonography (MUS) as a Surgical Adjuvant in Lung Cancer Staging. In: Zieliński, M., Rami-Porta, R. (eds) The Transcervical Approach in Thoracic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54565-8_8

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  • DOI: https://doi.org/10.1007/978-3-642-54565-8_8

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54564-1

  • Online ISBN: 978-3-642-54565-8

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