Which mediastinal lymph nodes should be examined during operation for diagnosing N0 or N1 disease in bronchogenic carcinoma?

Shinichiro Miyoshi, Shinji Maebeya, Takaomi Suzuma, Toshiya Bessho, Issei Hirai, Hirokazu Tanino, Tatsuya Yoshimasu, Junji Arimoto, Yasuaki Naito, Eisei Nishino

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)


We retrospectively reviewed the patterns of mediastinal metastasis in relation to the location of the, primary lung cancer in 55 p-N2 patients who underwent resection of the primary lesion and standard mediastinal lymphadenectomy. All (17/17, 100%) were diagnosed as N2 disease based on investigation of nodes 2, 3 and 4 in right upper lobe cancers, 91% (20/22)by examination of nodes 3,7 and 8 in right lower lobe cancers, 91% (10/11) by examination of nodes 4, 5 and 7 in left upper lobe cancers and 100% (5/5) by examination of nodes 4, 7, and 8 in left lower lobe cancers. As a prospective study, these 3 levels were investigated pathologically during operation by selecting one lymph node, which was most strongly suspected to be metastatic, from each level in 61 patients. The N status diagnosed by the frozen sections (f-N) was compared with the N status diagnosed by the permanent sections (p- N) obtained after the standard mediastinal dissection. The f-N was consistent with the p-N in 39 patients with N0 or N1 and in 16 patients with N2 or more. The f-N resulted in under-diagnosis in six patients, four of whom had a micrometastasis at one of the 3 levels. We concluded that the pathological examination of the 3 levels for each lobe during operation is useful to diagnose mediastinal N status and that limited mediastinal lymphadenectomy consisting of the 3 levels can be indicated for patients with negative f-N.

Original languageEnglish
Pages (from-to)475-484
Number of pages10
JournalJapanese Journal of Lung Cancer
Issue number4
Publication statusPublished - Aug 1997


  • Bronchogenic carcinoma
  • Frozen section examination
  • Mediastinal lymphadenectomy
  • Mediastinal metastasis

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


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