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    Does frozen section increase false negativity in cervical mediastinoscopy during mediastinal lymph node staging compared to paraffin section?
    (2020) Erdoğu, Volkan; Metin, Muzaffer; Sayar, Adnan; Büyükkale, Songül; Kiliçgün, Ali; Metin, Serda Kanbur; Pekçolaklar, Atilla
    Background: Cervical Mediastinoscopy (CM) is the most important invasive method in mediastinal lymph node staging. Lymph nodes dissected via CM can either be sent to frozen section (FS) for analysis allowing thoracotomy to be performed on the same session, or to paraffin section (PS) where thoracotomy is performed as a separate session (as a separate operation). This study compares the false- negative ratio of mediastinoscopic FS and PS analysis. Materials and Methods: 454 patients with primary lung cancer who have undergone CM between January 2003 and December 2005 have been retrospectively analysed. This study evaluates whether FS analysis increases the false-negative rate of lymph node biopsies. Results: 160 cases from the PS group and 113 cases from the FS group were included in the study. The mean age of the patients was 56.4 years (range 28-77 years). There were 260 men and 13 women. In the PS group, mean thoracotomy time after CM was 9.9 days. False negativity of CM in the PS and the FS groups was found to be 9.2% and 8%, respectively. Conclusion: There was no statistically significant difference in terms of false negativity between FS and PS in mediastinal staging (p = 0.598).
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    Prognostic stratification of patients with T3N1M0 non-small cell lung cancer: which phase should it be?
    (2012) Kılıçgün, Ali; Tanrıverdi, Özgür; Turna, Akif; Metin, Muzaffer; Sayar, Adnan; Solak, Okan; Ürer, Nur; Gürses, Atilla
    In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer. The present study aimed to evaluate the prognosis of patients with T3N1 disease as compared with that of patients with stages IIIA and IIB disease. During 7-year period, 313 patients with non-small cell lung cancer (297 men, 16 women) who had resection were enrolled. The patients were staged according the 2007 revision of Lung Cancer Staging by American Joint Committee on Cancer. The Kaplan-Meier statistics was used for survival analysis, and comparisons were made using Cox proportional hazard method. The 5-year survival of patients with stage IIIA disease excluding T3N1 patients was 40%, whereas the survival of the patients with stage IIB disease was 66% at 5 years. The 5-year survival rates of stage III T3N1 patients (singlestation N1) was found to be higher than those of patients with stage IIIA disease (excluding pT3N1 patients, P = 0.04), while those were found to be similar with those of patients with stage IIB disease (P = 0.4). Survival of the present cohort of patients with T3N1M0 disease represented the survival of IIB disease rather than IIIA non-small cell lung cancer. Further studies are needed to suggest further revisions in the recent staging system regarding T3N1MO disease.
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    Very important histopathological factors in patients with resected non-small cell lung cancer: Necrosis and perineural invasion
    (Georg Thieme Verlag Kg, 2010) Kılıçgün, Hacıali; Turna, Akif; Sayar, Adnan; Solak, O.; Ürer, N.
    Background: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. Methods: During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years. Results: Overall 5-year survival was 42.2%. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators (p = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors (p = 0.006, p = 0.001, p = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features (p = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis (p = 0.0001). Conclusions: Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.