Improved pre-operative mediastinal staging in non-small-cell lung cancer by serial sectioning and immunohistochemical staining of lymph-node biopsies
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Updated: Oct 5, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
J W Oosterhuis1, P H Theunissen, E C Bollen
1Department of Surgery, Atrium Medical Centre, 6401 CX Heerlen, The Netherlands. j.oosterhuis@tip.nl
Objective:
Mediastinal staging of non-small-cell lung carcinoma (NSCLC) by mediastinoscopy suffers from a low sensitivity, leading to a number of patients with unforeseen N2 disease at thoracotomy. This study was undertaken to assess whether pre-operative staging could be improved by serial sectioning and immunohistochemical staining of mediastinoscopy biopsies.
Methods:
In 183 consecutive patients with NSCLC, a thoracotomy was performed after a thorough mediastinal staging by computed tomography scan and cervical mediastinoscopy. In 158 patients (88%), a mediastinal node dissection was performed, revealing unforeseen N2 disease in 24 cases (15%). The preserved mediastinoscopy biopsies of these patients were retrospectively serially sectioned and stained with MNF 116.
Results:
Metastases could be identified in seven cases (30%), reducing unforeseen N2 disease from 15 to 10%. The number of patients who could theoretically benefit from neo-adjuvant therapy would have been increased by at least 10%.
Conclusions:
Pre-operative mediastinal staging can be improved considerably by serial sectioning and immunohistochemical staining of mediastinoscopic biopsy specimens.