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Ad b) The possibility that transpleural techniques for NSCLC diagnosis might involve a danger of relapse and worsening of prognosis has been discussed. Recently Sawabata et al. (2001) published the results obtained in their comparative studies on the frequencies of local and distant recurrence rates after transpleural and transbronchial procedures for NSCLC diagnosis, in which they investigated 45 and 195 cases, respectively.

Neither local nor distant relapse rates showed statistically significant differences. The survival rates were better in the transpleural diagnostic group (P = 0.04). The results are summarized in Table 15. The authors concluded from their results that transpleural diagnosis is an appropriate way to diagnose operable lung cancer that is difficult to verify by bronchoscopy, because this method does not affect relapse rates or prognosis.

Fig. 23. Topography of the situs with lymph node groups (N1-N3 positions) relevant for pre- and intraoperative node staging and decision making on operability. N1 = bronchopulmonary nodes. Overview of the localizations of bronchopulmonary and tracheobron-chial nodes. This scheme is basic to the development of radiological imaging-systems to localize sentinel node(s) and gives preoperatively answers about operability

Fig. 23. Topography of the situs with lymph node groups (N1-N3 positions) relevant for pre- and intraoperative node staging and decision making on operability. N1 = bronchopulmonary nodes. Overview of the localizations of bronchopulmonary and tracheobron-chial nodes. This scheme is basic to the development of radiological imaging-systems to localize sentinel node(s) and gives preoperatively answers about operability

Fig. 24 a, b. Preoperative staging using imaging systems (N1 position see Figs. 21, 23). a Evaluation of the nodes in aortopulmonary "window" (N2); b mediastinal nodes (N3). Demonstration of the exact localization of the nodes in the "aortopulmonary window"
Table 16. Intraoperative sentinel node search using "mTc-nanocolloid

No. of cases

Mean time labeling "mTc 63 (23-170) min

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