A mediastinoscopy with a biopsy is a minor surgical procedure used to gather samples of lymph nodes (clusters of cells play a key role in fighting off viruses and bacteria in your body). The sample is taken from your chest.
A surgeon inserts a small instrument with a light—called a mediastinoscope—through an incision in your throat. He or she runs it under your sternum (breastplate) and moves it into the area between your lungs. You will be under general anesthetic during the biopsy.
The test looks for any abnormalities and takes one or more small tissue samples, called biopsies, to be examined and assessed in a lab. This test is commonly used to check for cancer.
Your doctor might order a mediastinoscopy with a biopsy for several reasons. He or she may want to:
- see if a cancer in the lung has spread to the lymph nodes
- check for other lymphatic cancers, including Hodgkin’s disease or lymphoma
- identify infections, such as tuberculosis
According to the National Institutes of Health (NIH), doctors often use mediastinoscopy to help stage lung or other cancers, or to understand how far the disease has advanced. This information can help you and your doctor select the most appropriate course of treatment.
The stage of any type of cancer is based on several factors. These include:
- the size of the primary tumor
- whether the cancer has spread to distant parts of the body
- whether the lymph nodes are involved
A surgical team will perform your mediastinoscopy in a hospital or outpatient surgical center.
You should not eat or drink anything after midnight on the day before your test. Make sure to arrive at the surgery site at the scheduled time.
After you have checked in, a nurse will take you to a private room or cubicle. He or she will ask you to remove your clothes and jewelry and put on a hospital gown. The nurse will then start an IV in your hand, wrist, or arm. You may feel a short, sharp pain when the needle is inserted, but the discomfort will fade quickly. The nurse will tape the IV in place so that you don’t accidentally remove it.
When it is time for your procedure, a nurse or technician will take you into the operating room on a cot with wheels, called a gurney.
Once you are in the operating room, you will be helped onto the operating table and positioned on your back. An anesthesiologist will then inject a medication into your IV that will put you into a deep sleep. You will not feel pain during the procedure. Once you are unconscious, the doctor will place a flexible tube into your mouth and maneuver it into your lungs to help you breathe.
The surgeon will then make an incision at the base of your throat and thread the mediastinoscope into the space between your lungs.
He or she will examine the area visually. The surgeon will also remove a small piece of tissue from the lymph nodes and from any other area that looks inflamed, infected, or otherwise abnormal.
When this process is complete, the surgeon will withdraw the mediastinoscope, remove the breathing tube from your lungs, and suture (stitch) the small wound. The tissue samples will go to the laboratory for analysis.
You will wake up in the recovery room. The staff there will offer you pain medications and monitor your vital signs to make sure they remain stable. If you don’t suffer any complications, you will be allowed to go home within an hour or so.
Your throat will probably feel swollen and tender for a few days, and it may hurt to talk or to swallow. Talk to your doctor about the best medications to manage any pain.
Any time you receive general anesthesia, you run a slight risk of an allergic reaction to the medication. This can lead to difficulty in breathing.
The most serious risk during this surgery is the accidental puncture of blood vessels, which could lead to a fatal hemorrhage. This complication, however, is exceedingly rare.
When doctors look at the biopsies taken, they will study the size and shape of the cells in your tissue. This will determine whether they are normal (benign) or malignant (cancerous). This type of molecular cell study is called cytology.
If the problem is an infection, the tissue will be cultured to identify the bacteria and select the best antibiotic to treat it.