Mediastinoscopy Health Article

Diagnosis/Preparation

Because mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Individuals who previously had mediastinoscopy should not receive it again if there is scarring from the first exam.

Several other medical conditions, such as impaired cerebral circulation, obstruction or distortion of the upper airway, or thoracic aortic aneurysm (abnormal dilation of the thoracic aorta) may also preclude mediastinoscopy. Certain structures in a person's anatomy that can be compressed by the mediastinoscope may complicate these pre-existing medical conditions.

Patients are asked to sign a consent form after reviewing the risks of mediastinoscopy and known risks and reactions to anesthesia. The physician will normally instruct the patient to fast from midnight before the test until after the procedure is completed. A physician may also prescribe a sedative the night before the exam and again before the procedure. Often a local anesthetic will be applied to the throat to prevent discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored and watched for changes in vital signs, or symptoms of complications from the procedure or anesthesia. The patient may have a sore throat from the endotracheal tube, experience temporary chest pain, and have soreness or tenderness at the incision site.

Risks

Complications from the actual mediastinoscopy procedure are relatively rare. The overall complication rates in various studies have been reported in the range of 1.3–3%. However, the following complications, in decreasing order of frequency, have been reported:

• hemorrhage
• pneumothorax (air in the pleural space)
• recurrent laryngeal nerve injury, causing hoarseness
• infection
• tumor implantation in the wound
• phrenic nerve injury (injury to a thoracic nerve)
• esophageal injury
• chylothorax (chyle is milky lymphatic fluid in the pleural space)
• air embolism (air bubble)
• transient hemiparesis (paralysis on one side of the body)

The usual risks associated with general anesthesia also apply to this procedure.

Normal results

In the majority of procedures performed to diagnose cancer, a normal result indicates the presence of small, smooth lymph nodes, and no abnormal tissue, growths, or signs of infection. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

Morbidity and mortality rates

Abnormal findings may indicate lung cancer, tuberculosis, the spread of disease from one body part to another, sarcoidosis (a disease that causes nodules, usually affecting the lungs), lymphoma (abnormalities in the lymph tissues), and Hodgkin's disease.

Complications of mediastinoscopy include bleeding, pain, and post-procedure infection. These are relatively uncommon. Mortality is extremely rare.

Alternatives

A less invasive technique is ultrasound. However, it is not as specific as mediastinoscopy, and the information obtained is not as useful in making a diagnosis.

Although still performed, there is a decline in the use of mediastinoscopy as a result of advancements in computed tomography (CT), magnetic resonance imaging (MRI), and ultrosonography techniques. In addition, improved fine-needle aspiration (withdrawing fluid using suction) results of and core-needle biopsy (using a needle to obtain a small tissue sample) investigations, along with new techniques in thoracoscopy (examination of the thoracic cavity with a lighted instrument called a thoracoscope) offer additional options in examining masses in the mediastinum. Mediastinoscopy may be required when other methods cannot be used or when they provide inconclusive results.

See also Lung biopsy; Thoracic surgery.

BOOKS

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Fischbach, F. and F. Talaska A Manual of Laboratory and Diagnostic Tests 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Grace, P.A., A. Cuschieri, D. Rowley, N. Borley, A. Darzi Clinical Surgery 2nd Edition. London: Blackwell Publishing, 2003.

Schwartz, S.I., J.E. Fischer, F.C. Spencer, G.T. Shires, J.M. Daly, J.M. Principles of Surgery 7th edition. New York: McGraw Hill, 1998.

Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, D.C. Sabiston Sabiston's Review of Surgery 3rd Edition. Philadelphia: Saunders, 2001.

PERIODICALS

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Falcone F., F. Fois, D. Grosso. "Endobronchial Ultrasound." Respiration 70(2) (2003): 179–94.

Sterman, D.H., E. Sztejman, E. Rodriguez, J. Friedberg. "Diagnosis and Staging of 'Other Bronchial Tumors'." Chest Surgery Clinics of North America 13(1) (2003): 79–94.