Mediastinoscopy. An analysis of 320 consecutive cases

Cerebrovascular accident complicating extended cervical mediastinoscopy

The safety and efficacy of staging cervical mediastinoscopy is well established. Extended cervical mediastinoscopy has been proposed as a safe and effective method of staging left upper lobe lung cancers. We report a case of cerebrovascular accident complicating extended cervical mediastinoscopy.

Mediastinoscopy incisional metastasis. A radiotherapeutic approach

Tumor seeding of the mediastinoscopy tract has been described. Although it is a rare occurrence, it can present the radiation oncologist with a therapeutic dilemma. Two cases of mediastinoscopy scar recurrences are reported. Their response to treatment and a review of previous cases are included.

Pre-operative mediastinal evaluation in primary bronchial carcinoma--a review of staging investigations

A review of staging investigations in the preoperative evaluation of mediastinal involvement in primary bronchial carcinoma is presented. The following conclusions are offered as guidelines for the use of mediastinal staging procedures in clinical practice: Surgical staging methods have the over-riding advantage of superior specificity over indirect imaging techniques. Where 67Ga-imaging or CT scanning are not available, routine pre-operative mediastinoscopy or, when appropriate, mediastinotomy will identify most patients with non-resectable disease but this approach entails a high proportion of true negative examinations. Radioisotope ventilation and perfusion lung imaging has no place in the pre-operative staging of lung cancer. Where the techniques are available, 67Ga-imaging and CT scanning have a use in selecting patients for mediastinal exploration. A negative mediastinal 67Ga scan or a negative CT examination suggest that mediastinal exploration will be unrewarding in the vast majority of cases and may be omitted prior to thoracotomy. A positive mediastinal 67Ga scan or the demonstration of abnormal mediastinal nodes by CT is an indication for mediastinal exploration which, if negative should be followed by thoracotomy.

Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy

Forty-four patients coming to surgery for carcinoma of the bronchus underwent preoperative staging of the mediastinum by computed tomography (CT scanning) and surgical exploration of the mediastinum by cervical mediastinoscopy or left anterior mediastinotomy or both. Where mediastinal nodes were affected the sensitivity and specificity of computed tomography was inferior to that of mediastinoscopy (57% and 85% versus 71% and 100%). The sensitivity of computed tomography in predicting mediastinal invasion was superior to that of mediastinoscopy (77% v 46%), especially in the case of lower-lobe tumours (67% v 17%). Mediastinoscopy had the considerable advantage of 100% specificity. In the assessment of hilar lymphadenopathy computed tomography had a sensitivity of 38% and a specificity of 64%. In cases where computed tomography showed a normal mediastinum or enlargement of the hilar glands only, mediastinal exploration conferred no additional information and could have been omitted. A computed tomography scan showing mediastinal abnormality is an indication for mediastinoscopy and not a contraindication to surgery. In 23 patients computed tomography showed some abnormality of the mediastinum, confirmed at mediastinoscopy in 12 cases. The remaining 11 patients underwent thoracotomy, resection being carried out in nine. Postsurgical staging showed that six of these tumours were N0 lesions without invasion; in two further N0 cases there was a minor degree of mediastinal invasion which did not prevent resection, and the remaining tumour was N1 without invasion.

A late complication of a diagnostic mediastinoscopy

A 69-year-old man with a moderately well differentiated squamous-cell carcinoma of the lung, underwent a mediastinoscopy. All histological examinations of the mediastinal nodes were negative. The patient was treated with a curative left pneumonectomy. Three months after this negative mediastinoscopy the patient developed a metastasis in the mediastinoscopy scar. A report of this case and a review of the literature are presented.

Tuberculosis and mediastinoscopy

Biopsy of lymph nodes at mediastinoscopy has been the method of diagnosis of tuberculosis in 14 patients; Mycobacterium tuberculosis was cultured from the nodes in nine cases, and in five there was histological evidence of the disease but cultural confirmation was lacking. All patients had radiographic abnormality of the superior mediastinum, and a frequent finding at mediastinoscopy was mediastinal fibrosis involving the fascia and lymph nodes. No cause other than tuberculosis could be demonstrated to account for the mediastinal fibrosis, and the patients made clinical recoveries in response to standard courses of antituberculosis chemotherapy. The development of superior vena caval compression was not observed.