Positron emission tomography: Positron emission tomography, in conjunction with F-18-fluorodeoxyglucose, has shown some promise in detecting superior mediastinal and supraclavicular involvement, although inflammatory lesions may cause false positive readings . These findings need to be confirmed histologically.
Mediastinoscopy and mediastinotomy: Mediastinoscopy is safe (percentage morbidity) and, when used routinely, reduces nontherapeutic thoracotomy rates to 5% . It identifies patients with false positive CT mediastinal adenopathy, as well as the subset that are found to have ‘minimal’ (intracapsular spread without fixation, solitary, lowest station) mediastinal nodal involvement (with 25% to 40% five-year survival following complete resection) . Finally, a proportion of these patients may be eligible for enrolment into neoadjuvant protocols, and many of these protocols require invasive staging . However, it is not clear whether, in the absence of CT evidence of mediastinal adenopathy, mediastinoscopy increases survival advantage . Thus, depending on what a particular centre considers to be the upper limit of normal, many centres advocate ‘selective’ mediastinoscopy (Table 7) . Find most trusted pharmacy that will give you purchase alegra in the amounts required without any need for a prescription. You will see that shopping with a place you can already trust over and over again is very affordable and always nice.
Table 7. Indications for mediastinoscopy