Are frozen sections of mediastinoscopy samples as effective as formal paraffin assessment of mediastinoscopy samples for a decision on a combined mediastinoscopy plus lobectomy?

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'Are frozen sections of mediastinoscopy samples as effective as formal paraffin assessment of mediastinoscopy samples for a decision on a same-day lobectomy?'. Five papers were found using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. These studies compared the efficacy and accuracy of frozen sections (FSs) from mediastinal lymph nodes for staging of patients with lung cancer to determine whether a combined procedure can be planned based on these results and to proceed to thoracotomy and lung resection in cases of negative mediastinal nodes diagnosed by FS. These studies unanimously showed that FS of mediastinal nodes are as accurate as permanent section results and definite histology diagnosis with a sensitivity of >94% and specificity of 100% with no false-positive results. They also confirmed that even in benign lung conditions and other malignancies of the mediastinum, the results of FS are compared with the histology of the node. Based on the current reports, a combined procedure (staging mediastinal nodes by FS and planning for thoracotomy or abandoning thoracotomy) is a safe approach to treat non-small-cell lung cancer (NSCLC). From the patients' point of view, this approach is superior to the staged procedure (mediastinoscopy followed by lung resection at a later date based on the histology of mediastinal nodes) due to single hospitalization and anaesthesia, however whether it is cost effective or not is debatable. It is also labour-intensive and operator-dependent. In conclusion, the current evidence in the literature suggests that a combined procedure of mediastinal node FS followed by lung resection can be a safe alternative to a staged approach to this disease.