回复：求助 - 父亲不幸得了肺癌 要做纵隔镜

Sorry to hear your dad's lung cancer.

Here is my 2 cents (hope you can still get to read it, I don't come to here too often).

1. "The devil is in the details". The MDs in China suspected that there is LEFT lung hilum meastasis. Now is the lymphanode in left hilum PET positive? If the left hilum lymphanodes also have high PET SUV uptake, then there is NO need to do the mediastinoscopy because the mediastinoscope cannot access the hilum nodes. SO the mediastinoscopy will not change the manegement option. If there are enlarged mediastinum lymphanodes with PET SUV that high, then those nodes are metastatic nodes so you do not need a mediastinoscopy to confirme it. Also, one cannot "clean" all the mediastinum nodes when they are big or they cannot be reached. Plus, are they going to do another CT/PET after mediastinoscopy? If not, how can they certain that they got the nodes which are hot on the first PET? The bottomline: if the mediastinum nodes have SUV that high and there is positive left hilum nodes, then mediastinoscopy does not help.

2. Again, details. You said there are lung noduleS. How many of them are there? How many of them, which are greater than 7mm in size, are PET positive? If there is only one positive dorminate nodule and your father's general condition is OK, then there are other options in major centers in US, even there are positive nodes elsewhere. One of the procedure routinely done is CT-guided RF ablation. Interventional radiologist or thoracic surgeon can put an RF probe into the center of that 1.9 cn lung nodule and kill any tissue within a 3cm diameter. This is a procedure very similar to the biopsy he already had. After that one can still go through cycles of chemo and RT. It has a much better cure rate for small cancer nodules.

Hope that helps. Best of luck!!!