Mediastinoscopy: trends and practice patterns in the United States.

TitleMediastinoscopy: trends and practice patterns in the United States.
Publication TypeJournal Article
Year of Publication2013
AuthorsVyas KS, Davenport DL, Ferraris VA, Saha S
JournalSouth Med J
Volume106
Issue10
Pagination539-44
Date Published2013 Oct
ISSN1541-8243
KeywordsAged, Databases, Factual, Female, Humans, Lung Neoplasms, Male, Mediastinoscopy, Middle Aged, Neoplasm Staging, Practice Patterns, Physicians', United States
Abstract

OBJECTIVES: Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. A practice gap exists as the result of a variation in knowledge concerning current trends and practice patterns of mediastinoscopy usage. In addition, there are regional variations in practice-based learning and patient care. Lessons learned during surgeries performed on patients with lung cancer and other advances such as positron emission tomography and endobronchial ultrasound could be universally applied to improve surgeons' management of patient care. The purpose of this study was to assess contemporary practices in the staging of lung cancer.

METHODS: We queried the Society of Thoracic Surgeons National Database for data regarding mediastinoscopy usage, yield, and variation, both by year and region.

RESULTS: Cases with mediastinoscopy, as a percentage of all cases performed in the database, have significantly decreased from 14.6% in 2006 to 11.4% in 2010 (P < 0.001). The 5-year median rate of mediastinoscopy in lung cancer patients at 163 centers was 15.3% (interquartile range 5.2%-31.7%), indicating significant variation among centers. The overall median center rate also decreased over time from 21.4% (2006) to 10.0% (2010).

CONCLUSIONS: With advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly. Our findings are likely to be relevant to both clinical practice and practice guidelines.

DOI10.1097/SMJ.0000000000000000
Alternate JournalSouth. Med. J.
PubMed ID24096946
PubMed Central IDPMC4387790
Grant ListUL1 RR033173 / RR / NCRR NIH HHS / United States
UL1 TR000117 / TR / NCATS NIH HHS / United States