The value of cervical mediastinoscopy in the diagnosis of mediastinal lymphadenopathy

Abstract

Objective. This study retrospectively evaluated mediastinoscopic interventions performed for diagnostic purposes in cases with mediastinal lesions remained undiagnosed by other diagnostic methods. Methods. We retrospectively evaluated the medical information of 218 patientss that underwent diagnostic cervical mediastinoscopy for mediastinal lymphadenopathy apart from lung cancer staging between January 2011 and December 2015. The patients were evaluated for age, sex, distribution of sampled lymph node stations detected to have lymphadenopathy, intraoperative and postoperative mortality and morbidity, and histopathological diagnostic parameters. The gender-based distribution of the disease types diagnosed by cervical mediastinoscopy were analyzed with the Chi-Square test. Results. Two hundred and six (94.5%) of 218 patients were diagnosed by cervical mediastinoscopy. The most common diagnosis was sarcoidosis in women and bronchogenic carcinoma in men. Nineteen (8.7%) patients suffered minor complications, with pain being the most common; no major complication occurred. Conclusion. The present study shows that mediastinoscopy is still an invasive diagnostic method with high diagnostic accuracy that can be safely used with low rates of mortality and morbidity in a large proportion of patients with mediastinal lymphadenopathy of undetermined origin. 

Keywords

• Cervical mediastinoscopy,mediastinal lymphadenopathy,mediastinum,videomediastinoscopy

References

1. [1] Kirby T, Fell S. Mediastinoscopy. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg R, Hiebert C, Patterson GA, Urschel H, editors. Thoracic surgery. New York: Churchill Livingstone 2002;p. 98-103.
2. [2] Gurses A. [Mediastinoscopy]. Turkiye Klinikleri J Int Med Sci 2006;2:53-6. [Article in Turkish]
3. [3] Porte H, Roumilhac D, Eraldi L, Cordonnier C, Puech P, Wurtz A. The role of mediastinoscopy in the diagnosis of mediastinal lymphadenopathy. Eur J Cardiothorac Surg 1998;13:196-9.
4. [4] Sarrazin R, Dyon JF. [Mediastinoscopy]. Rev Mal Respir 1992;9:99- 110. [Article in French]
5. [5] Pattison CW, Westaby S, Wetter A, Townsend ER. Mediastinoscopy in the investigation of primary mediastinal lymphadenopathy. Scand J Thorac Cardiovasc Surg 1989;23:177-9.
6. [6] Eldaboosy SAM, Zeinnhom RA, Kanany H, Nour MO. The value of cervical mediastinoscopy in the diagnosis of mediastinal lesions. Egypt J Chest Dis Tuberc 2015;64:755-60.
7. [7] Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997;111:1718-23.
8. [8] Hasdiraz L, Kahraman A, Bilgin M, Oguzkaya F. [Mediastinoscopy for T1 non-small cell lung carcinoma]. Turkiye Klinikleri J Med Sci 2007;27:677-9. [Article in Turkish]

9. [9] Borges N, Sibu Saha S. The value of mediastinoscopy in the management of thoracic disease. Indian J Thorac Cardiovasc Surg 2012;28:116-9.
10. [10] Deslauriers J, Letourneau L, Giubilei G. Tumors and masses: diagnostic strategies in mediastinal tumors and masses. In: Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Hiebert CA, Patterson GA, et al, editors. Thoracic surgery. Vol. 2, 2nd ed. New York: Churchill Livingston; 2002. p. 1655-73.
11. [11] Le Jeune I, Baldwin D. Measuring the success of transbronchial needle aspiration in everyday clinical practice. Respir Med 2007;101:670-5.
12. [12] Hsu HS, Wang LS, Hsieh CC, Wang CY, Wu YC, Huang BS, et al. The role of mediastinoscopy in the evaluation of thoracic disease and lung cancer. J Chin Med Assoc 2003;66:231-5.
13. [13] Zwischenberger JB, Savage C, Alpard SK, Anderson CM, Marroquin S, Goodacre BW. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest 2002;121:1165-70.
14. [14] Raveglia F, Meda S, Conforti S, Leporati A, Calati AM, Squinzi R, et al. Diagnostic value and learning curve of transbronchial needle aspiration in thoracic surgery. Minerva Chir 2006;61:459-66.
15. [15] McNeill TM, Chamberlain JM. Diagnostic anterior mediastinotomy. Ann Thorac Surg 1966;2:532-9.
16. [16] Ginsberg RJ, Rice TW, Goldberg M, Waters PF, Schmocker BJ. Extended cervical mediastinoscopy. A single staging procedure for bronchogenic carcinoma of the left upper lobe. J Thorac Cardiovasc Surg 1987;94:673-8.
17. [17] Hinterthaner M, Stamatis G. [Role of mediastinoscopy and repeat mediastinoscopy today]. Chirurg 2008;79:38-44. [Article in German]
18. [18] Landreneau RJ, Hazelrigg SR, Mack MJ, Fitzgibbon LD, Dowling RD, Acuff TE, et al. Thoracoscopic mediastinal lymph node sampling: useful for mediastinal lymph node stations inaccessible by cervical mediastinoscopy. J Thorac Cardiovasc Surg 1993;106:554-8.
19. [19] Inzirillo F, Giorgetta C, Ravalli E, Tiberi S, Pona CD. Videomediastinoscopy: a ten year experience on lung cancer stadiation and non-diagnosed mediastinal lymphoadenopathy. Chirurgia (Bucur) 2014;109: 451-4.
20. [20] Gossot D, Toledo L, Fritsch S, Celerier M. Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study. Chest 1996;110:1328-31.
21. [21] Chauhan A, Kapoor S, Ganguly M, Nath P. Cervical mediastinoscopy: re-evaluation of an old technique in era of new imaging technology, Indian J Chest Dis. Allied Sci 2012;54:169-73.
22. [22] Kir A, Baysungur SV, Baran R, Akso F, Pandul I, Atasalihi A. [Diagnostic mediastinoscopy]. Turk Gogus Kalp Dama 1994;2:347-9. [Article in Turkish].
23. [23] Yuksel M, Akgun S, Pasa S. Intratorasik lezyonlarin tanisinda ve tedavisinin planlanmasinda mediyastinoskopinin rolu ve inemi. Solunum Hastaliklari Dergisi 1996;7:21-7.