Mediastinoscopy and bronchial carcinoma: experience with 600 mediastinoscopies

Mediastinal staging in non-small-cell lung cancer

Decision analysis was used to study the approach to staging mediastinal involvement in patients with non-small-cell lung cancer (NSCLC). Various diagnostic strategies for mediastinal disease staging using computed tomography (CT), mediastinoscopy, and bronchoscopy with transbronchial needle aspiration (TBNA), either individually or in series, were compared and found to result in similar patient life expectancies. Two strategies, one using bronchoscopy and TBNA alone and the other using it in combination with CT, were consistently least expensive across a wide range of prior probabilities, test characteristics, and charges. The authors conclude that strategies for staging mediastinal involvement in NSCLC that rely on bronchoscopy and TBNA are preferable because they are least expensive.

Mediastinal assessment for staging and treatment of carcinoma of the lung

Invasive diagnostic procedures for mediastinal assessment, such as mediastinoscopy, are necessitated by the importance of staging lung cancers, both to plan the treatment and to estimate the prognosis. Other noninvasive techniques may complement or be substituted for mediastinoscopy under certain specific clinical settings. Thus with the introduction of newer diagnostic technologies, such as computed axial tomography, the strategy for mediastinal assessment should be continually reevaluated. In this review, the diagnostic sensitivity, specificity, and overall accuracy of various techniques reported in the literature are examined to elucidate their current roles in assessing the mediastinal involvement in patients with lung cancer.

Radiologic evaluation of the mediastinum

New imaging techniques have had a major impact on radiologic evaluation of the mediastinum. Computed tomography has led the way in defining internal anatomy noninvasively. Ultrasound plays a small but well-defined role in the evaluation of certain mediastinal masses. Digital vascular imaging has, in certain instances, replaced conventional angiography, though it seems unlikely to render conventional angiography obsolete. Other modalities such as magnetic resonance imaging are being applied and promise to become even more important in the near future. Finally, mediastinal sampling by needle biopsy under radiologic guidance has been shown to be a reliable technique when appropriately utilized.