{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T23:48:43Z","timestamp":1782776923387,"version":"3.54.5"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>The purpose of this study was to assess the quality of video-assisted cervical mediastinoscopy (VACM) in the staging of non-small-cell lung cancer (NSCLC) at the Antwerp University Hospital with a focus on test effectiveness indicators, morbidity and unforeseen pN2 results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>All consecutive VACM workups of cases of NSCLC performed between January 2010 and December 2015 were included to assess overall test quality and effectiveness. Quality assurance was performed in accordance with the recommendations of the European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons (ESTS) where appropriate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A total of 168 video-assisted cervical mediastinoscopies were included. A total of 91.7% of the procedures were performed in accordance with the ESTS guideline. An unforeseen pN2 staging was identified in 10 anatomical lung resections (8.6%). Statistical analysis showed no significant association between VACM performed in accordance with the ESTS guideline and the presence of pN2 positive lymph nodes [\u03c72 (1) = 0.61; P\u2009=\u20090.57] and no association between VACM performed in accordance with the ESTS guideline and overall futile thoracotomy [\u03c72 (1) = 0.76; P\u2009=\u20090.50]. Calculations revealed a sensitivity of 81.8 [95% confidence interval (CI) 69.1\u201390.9], specificity of 100%, positive predictive value of 100%, negative predictive value of 91.9% (95% CI 86.6\u201395.2) and diagnostic accuracy of 94.1% (95% CI 89.33\u201397.11).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Overall, 91.7% of the VACM were performed in accordance with the ESTS guideline. This process resulted in a sensitivity of 81.8%, a negative predictive value of 91.9% and an unforeseen pN2 rate of 8.6%.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivaa263","type":"journal-article","created":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T03:20:28Z","timestamp":1602904828000},"page":"270-275","source":"Crossref","is-referenced-by-count":10,"title":["Evaluation of mediastinoscopy in mediastinal lymph node staging for non-small-cell lung cancer"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4346-955X","authenticated-orcid":false,"given":"Ian","family":"Diebels","sequence":"first","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9145-3643","authenticated-orcid":false,"given":"Jeroen M H","family":"Hendriks","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7872-8622","authenticated-orcid":false,"given":"Jan P","family":"Van Meerbeeck","sequence":"additional","affiliation":[{"name":"Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7394-4614","authenticated-orcid":false,"given":"Patrick","family":"Lauwers","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1464-163X","authenticated-orcid":false,"given":"Annelies","family":"Janssens","sequence":"additional","affiliation":[{"name":"Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh K","family":"Yogeswaran","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1962-8821","authenticated-orcid":false,"given":"Paul E Y","family":"Van Schil","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"2022030919164227400_ivaa263-B1"},{"key":"2022030919164227400_ivaa263-B2","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1183\/09031936.00035108","article-title":"Integrated PET\/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration","volume":"33","author":"De Wever","year":"2009","journal-title":"Eur Respir J"},{"key":"2022030919164227400_ivaa263-B3","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/S0022-5223(19)39559-5","article-title":"Lymph node mapping and curability at various levels of metastasis in resected lung cancer","volume":"76","author":"Naruke","year":"1978","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022030919164227400_ivaa263-B4","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/ejcts\/ezu028","article-title":"Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer","volume":"45","author":"De Leyn","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022030919164227400_ivaa263-B5","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1055\/s-0030-1271148","article-title":"Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma?","volume":"60","author":"Sivrikoz","year":"2012","journal-title":"Thorac Cardiovasc Surg"},{"key":"2022030919164227400_ivaa263-B6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1378\/chest.36.4.343","article-title":"Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum","volume":"36","author":"Carlens","year":"1959","journal-title":"Dis Chest"},{"key":"2022030919164227400_ivaa263-B7","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1055\/s-0034-1392040","article-title":"Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS)","volume":"47","author":"Vilmann","year":"2015","journal-title":"Endoscopy"},{"key":"2022030919164227400_ivaa263-B8","volume-title":"International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology","author":"Goldstraw","year":"2009","edition":"1st edn"},{"key":"2022030919164227400_ivaa263-B9","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"2022030919164227400_ivaa263-B10","first-page":"10","volume-title":"Beyond Normality: The Predictive Value and Efficiency of Medical Diagnoses","author":"Galen","year":"1975"},{"key":"2022030919164227400_ivaa263-B11","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.thorsurg.2011.12.003","article-title":"Invasive staging of mediastinal lymph nodes: mediastinoscopy and remediastinoscopy","volume":"22","author":"Rami-Porta","year":"2012","journal-title":"Thorac Surg Clin"},{"key":"2022030919164227400_ivaa263-B12","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1016\/j.athoracsur.2010.02.012","article-title":"Video-assisted mediastinoscopy compared with conventional mediastinoscopy: are we doing better?","volume":"89","author":"Anraku","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B13","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.athoracsur.2011.02.032","article-title":"A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy","volume":"92","author":"Cho","year":"2011","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12893-018-0359-6","article-title":"MEDIASTinal staging of non-small cell lung cancer by endobronchial and endoscopic ultrasonography with or without additional surgical mediastinoscopy (MEDIASTrial): study protocol of a multicenter randomised controlled trial","volume":"18","author":"Bousema","year":"2018","journal-title":"BMC Surg"},{"key":"2022030919164227400_ivaa263-B15","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.athoracsur.2006.05.023","article-title":"Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate","volume":"82","author":"Lemaire","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B16","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.athoracsur.2012.01.033","article-title":"Complication rates in mediastinoscopy and training: video versus conventional mediastinoscopy","volume":"94","author":"Zakkar","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B17","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1016\/j.ejca.2008.11.043","article-title":"Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis","volume":"45","author":"Gu","year":"2009","journal-title":"Eur J Cancer"},{"key":"2022030919164227400_ivaa263-B18","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/j.athoracsur.2016.05.110","article-title":"Endosonography versus mediastinoscopy in mediastinal staging of lung cancer: systematic review and meta-analysis","volume":"102","author":"Sehgal","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B19","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1001\/jama.2010.1705","article-title":"Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer","volume":"304","author":"Annema","year":"2010","journal-title":"JAMA"},{"key":"2022030919164227400_ivaa263-B20","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/JTO.0000000000000388","article-title":"Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer","volume":"10","author":"Um","year":"2015","journal-title":"J Thorac Oncol"},{"key":"2022030919164227400_ivaa263-B21","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.jtcvs.2011.08.037","article-title":"A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer","volume":"142","author":"Yasufuku","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2022030919164227400_ivaa263-B22","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1016\/j.ejca.2013.02.008","article-title":"Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis","volume":"49","author":"Zhang","year":"2013","journal-title":"Eur J Cancer"},{"key":"2022030919164227400_ivaa263-B23","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.jtho.2019.02.032","article-title":"Unforeseen N2 disease after negative endosonography findings with or without confirmatory mediastinoscopy in resectable non\u2013small cell lung cancer: a systematic review and meta-analysis","volume":"14","author":"Bousema","year":"2019","journal-title":"J Thorac Oncol"},{"key":"2022030919164227400_ivaa263-B24","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/jnci\/djk093","article-title":"Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer","volume":"99","author":"van Meerbeeck","year":"2007","journal-title":"J Natl Cancer Inst"},{"key":"2022030919164227400_ivaa263-B25","doi-asserted-by":"crossref","first-page":"4194","DOI":"10.1200\/JCO.2015.62.6812","article-title":"Phase III study of surgery versus definitive concurrent chemoradiotherapy boost in patients with resectable stage IIIA(N2) and selected IIIB non-small-cell lung cancer after induction chemotherapy and concurrent chemoradiotherapy (ESPATUE)","volume":"33","author":"Eberhardt","year":"2015","journal-title":"J Clin Oncol"},{"key":"2022030919164227400_ivaa263-B26","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1097\/JTO.0000000000000678","article-title":"The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer","volume":"10","author":"Asamura","year":"2015","journal-title":"J Thorac Oncol"},{"key":"2022030919164227400_ivaa263-B27","doi-asserted-by":"crossref","first-page":"S1153","DOI":"10.21037\/jtd.2019.04.36","article-title":"Surgery for stage IIIA-N2 non-small cell lung cancer: the jury is still out!","volume":"11","author":"Berzenji","year":"2019","journal-title":"J Thorac Dis"},{"key":"2022030919164227400_ivaa263-B28","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.athoracsur.2008.04.042","article-title":"Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer","volume":"86","author":"Cerfolio","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B29","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.athoracsur.2013.09.101","article-title":"Survival of patients with unsuspected pN2 non-small cell lung cancer after an accurate preoperative mediastinal staging","volume":"97","author":"Obiols","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2022030919164227400_ivaa263-B30","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5090\/kjtcs.2013.46.1.49","article-title":"Long term survival of patients with unsuspected N2 disease in non-small cell lung cancer","volume":"46","author":"Lee","year":"2013","journal-title":"Korean J Thorac Cardiovasc Surg"}],"container-title":["Interactive CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/32\/2\/270\/42780846\/ivaa263.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/32\/2\/270\/42780846\/ivaa263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T19:18:09Z","timestamp":1646853489000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/32\/2\/270\/6012937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,30]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,11,30]]},"published-print":{"date-parts":[[2021,1,22]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaa263","relation":{},"ISSN":["1569-9285"],"issn-type":[{"value":"1569-9285","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,2,1]]},"published":{"date-parts":[[2020,11,30]]}}}