Cervical Mediastinoscopy: Re-evaluation of an Old Technique in Era of New Imaging Technology
Ashutosh Chauhan, S. Kapoor, M. Ganguly, P. Nath
Citation Information :
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 (3):169-173.
Context. With the advent of modern anatomical and functional imaging technologies, application of cervical mediastinoscopy has decreased in diagnosis and staging of mediastinal diseases.
Aim. To evaluate the usefulness of cervical mediastinoscopy in assessing the mediastinal disease when imaging modalities are non-diagnostic.
Settings and Design. Retrospective analysis of records of a tertiary care hospital.
Patients and Methods. Thirty-nine patients with mediastinal pathology of varied aetiologies underwent cervical mediastinoscopy. Pre- and post-operative diagnosis was compared.
Results. In 34 out of 39 cases (87.5%), cervical mediastinoscopy provided a confirmatory final diagnosis. One case had a major complication in the form of recurrent laryngeal nerve palsy.
Conclusion. Cervical mediastinoscopy is useful, minimally invasive modality in a scenario where anatomical and functional imaging tools are non-diagnostic.
Harken DE, Black H, Clauss R, Farrand RE. A simple cervicomediastinal exploration for tissue diagnosis of intrathoracic disease; with comments on the recognition of inoperable carcinoma of the lung. N Engl J Med 1954;251:1041-6.
Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959;36:343-52.
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.
Kirschner PA. Cervical mediastinoscopy. Chest Surg Clin N Am 1996;6:1-20.
Lemaire A, Nikolic I, Petersen T, Haney JC, Toloza EM, Harpole DH Jr, et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 2006;82:1185-9.
Rami PR. Surgical exploration of the mediastinum by mediastinoscopy, parasternal mediastinotomy and remediastionoscopy: indication, technique and complications. Ann Ital Chir 1999;70:867-72.
McManus TE, Haydock DA, Alison PM, Kolbe J. Isolated mediastinal adenopathy: the case for mediastinoscopy. Ulster Med J 2008;77:97-101.
Gupta SK, Gupta S. Sarcoidosis in India: a review of 125 biopsy proven cases in eastern India. Sarcoidosis 1990;7:43-9.
Shah A. Is sarcoidosis still uncommon in India. Indian J Chest Dis Allied Sci 2003;45:93-5.
Sayar A, Ölçmen A, Metin M, Güleç H, Demir A, Ölçmen M. Role of mediastinoscopy in intrathoracic tuberculous lymphadenitis. Asian Cardiovasc Thorac Ann 2000;8:253-5.
De Leyn P, Stroobants S, De Wever W, Lerut T, Coosemans W, Decker G, et al. Prospective comparative study of integrated positron emission tomographycomputed tomography scan compared with remediastinoscopy in the assessment of residual mediastinal lymph node disease after induction chemotherapy for mediastinoscopy proven stage IIIA-N2 non-small cell lung cancer: a Leuven Lung Cancer Study Group. J Clin Oncol 2006;24:3333-9.
Dietlein M, Weber K, Gandjour A, Moka D, Theissen P, Lauterbach KW, et al. Cost-effectiveness of FDG-PET for the management of potentially operable non-small cell lung cancer: priority for a PET-based strategy after nodalnegative CT results. Eur J Nucl Med 2000;27:1598-609.
van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet 2002;359:1388-93.
Kernstine KH, Mclaughlin KA, Menda Y, Rossi NP, Kahn DJ, Bushnell DL, et al. Can FDG-PET reduce the need for mediastinoscopy in potentially resectable nonsmall cell lung cancer? Ann Thorac Surg 2002;73:394-402.
Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996;23:1409-15.
Dosios T, Theako N, Chatziantoniou C. Cervical mediastinoscopy and anterior mediastinotomy in superior vena cava obstruction. Chest 2005;128:1551-6.
Bocking A, Klose KC. Cytologic versus histologic evaluation of needle biopsy of lung, hilum and mediastinum: sensitivity, specificity and typing accuracy. Acta Cytol 1995;39:463-71.
Das DK. Value and limitations of fine-needle aspiration cytology in diagnosis and classification of lymphomas: a review. Diagn Cytopathol 1999;21:240-9.
Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997;111: 1718-23.