The aim of this study is to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the unsuspected (u) N2-3 rates in patients with non-small cell lung cancer (NSCLC) and normal mediastinum by integrated positron emission tomography (PET) - computed tomography (CT). Prospective observational single-center study of 603 consecutive VAMLAs from 2010 to 2022. Exclusion criteria: other indications (n=32); tumors different from NSCLC (n=91); cN2-3 tumors by PET-CT (n=46). Systematic nodal dissection was the gold standard to validate negative VAMLAs. Those patients with negative VAMLA and missing reference standard test were excluded. uN2-3 rates were analyzed in the global series and in the subgroups of tumors according to their clinical nodal and tumor categories. Pathologic findings were reviewed, and staging values were calculated. 383 patients with clinical (c) N0-1 NSCLC underwent VAMLA. Staging values of VAMLA were: sensitivity, 0.98 (95% CI: 0.92– 0.99); negative predictive value, 0.99 (95% CI: 0.98–1); and diagnostic accuracy, 0.99 (95% CI: 0.98-1). The uN2-3 rate for the whole series (n=383) was 18.8%. The uN2-3 rates according to presurgical nodal and tumor categories determined by PET-CT were: 3.6% (4/111) in cT1N0; 16.3% (18/110) in cT2N0; 10,25% (4/39) in cT3N0; 32% (7/22) in cT4N0. 42% (39/93) in cN1; Complication rate: 7%. This series of NSCLC with normal mediastinum staged by VAMLA demonstrates a high accuracy of this technique and a high rate of uN2-3 disease (specially in cN1 and cT4N0). VAMLA could be considered the reference staging procedure for staging cN0-1 NSCLC.

中文翻译：

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视频辅助纵隔镜淋巴结切除术（VAMLA）：纵隔正常的非小细胞肺癌分期的成熟结果

本研究的目的是通过整合正电子发射断层扫描分析视频辅助纵隔镜淋巴结切除术 (VAMLA) 的准确性以及非小细胞肺癌 (NSCLC) 和正常纵隔患者的意外 (u) N2-3 率。 PET）-计算机断层扫描（CT）。对 2010 年至 2022 年 603 例连续 VAMLA 进行的前瞻性观察性单中心研究。排除标准：其他适应症（n=32）；与 NSCLC 不同的肿瘤 (n=91)；通过 PET-CT 检测 cN2-3 肿瘤 (n=46)。系统性淋巴结清扫是验证阴性 VAMLA 的金标准。那些 VAMLA 阴性且缺少参考标准测试的患者被排除在外。根据临床淋巴结和肿瘤类别，对全球系列和肿瘤亚组中的 uN2-3 率进行了分析。回顾病理结果并计算分期值。383 名临床 (c) N0-1 NSCLC 患者接受了 VAMLA。VAMLA 分期值为：敏感性，0.98（95% CI：0.92-0.99）；阴性预测值，0.99（95% CI：0.98–1）；诊断准确度为 0.99（95% CI：0.98-1）。整个系列 (n=383) 的 uN2-3 率为 18.8%。根据 PET-CT 确定的术前淋巴结和肿瘤类别，uN2-3 率为： cT1N0 中为 3.6% (4/111)；cT2N0 中为 16.3% (18/110)；cT3N0 中为 10.25% (4/39)；cT4N0 中为 32% (7/22)。cN1 中为 42% (39/93)；并发症发生率：7%。通过 VAMLA 分期的这一系列纵隔正常的 NSCLC 证明了该技术的高精度和 uN2-3 疾病的高发生率（特别是在 cN1 和 cT4N0 中）。VAMLA 可被视为 cN0-1 NSCLC 分期的参考分期程序。