Preoperative detection of micrometastases in the mediastinal lymph node (LN) during transcervical extended mediastinal lymphadenectomy (TEMLA) in patients with stage I and II non-small cell lung cancer (NSCLC) may contribute to better patient selection for curative surgery, according to results of a study presented at the International Association for the Study of Lung Cancer (IASLC) 17th Annual World Conference on Lung Cancer in Austria.1 The presence of micrometastases in the mediastinal LN is associated with significantly reduced 5-year survival, the study found.

Recurrence occurs in 30% to 50 % of patients with early stage NSCLC who undergo surgical resection, which indicates the possible existence of occult metastases at the time of surgery, the authors said. Because of this, they performed a retrospective study to determine if there is a prognostic significance of preoperatively detected mediastinal LN micrometastases in patients stage I/II NSCLC who are treated with radical surgical resection.

Eighty-two patients with stage I and 67 patients with stage II NSCLC underwent TEMLA and subsequent radical pulmonary resection between January 2007 and December 2010. The researchers resected 4841 mediastinal LNs during TEMLA, which were determined to be metastasis-free using hematoxylin and eosin staining. The samples were then labeled to detect occult micrometastases with dual immunohistochemical staining using AE1/AE3 and BerEP4 antibodies.

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Micrometastases were detected in mediastinal LN of 16 patients (9.7%). Eleven patients had only 1 LN station affected (68.8%). There was a significant correlation between the presence of micrometastases and tumor size.

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Five-year total survival was significantly better for patients with stage I (64.1%) and stage II (44.4%) NSCLC without micrometastases compared to those with micrometastases (18.8%). Multivariate analysis determined that the presence of micrometastases was the only significant prognostic factor for 5-year total survival.


  1. Gwóźdź P, Pasieka-Lis M, Kolodziej K, Pankowski J, Zieliński P. prognostic significance of micrometastases in mediastinal lymph nodes of patients with radically resected non-small cell lung cancer. Paper presented at: International Association for the Study of Lung Cancer 17th World Conference on Lung Cancer; December 2016; Vienna, Austria.