What Is Mediastinoscopy with Biopsy?

A mediastinoscopy with biopsy is a minor surgical procedure that gathers samples of lymph nodes. Lymph nodes are clusters of cells that play a key role in fighting off viruses and bacteria in your body. A surgeon takes the tissue sample from your chest.

A surgeon inserts a small instrument with a light—called a mediastinoscope—through an incision in your throat. They run it under your sternum (breastplate) and move it into the area between your lungs. You’ll be under general anesthetic during the biopsy.

The test looks for any abnormalities and takes one or more small tissue samples, called biopsies. Lab technicians examine and assess the biopsies in a lab. This test commonly checks for cancer.

Your doctor might order a mediastinoscopy with biopsy for several reasons. They 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

Doctors often use mediastinoscopy to understand how far lung or other cancers have advanced. This is also known as staging the cancer, or determining what stage your cancer has reached. This information can help you and your doctor select the most appropriate course of treatment.

Doctors base the stage of any type of cancer on several factors. These include:

  • the size of the primary tumor
  • whether the cancer is present in 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 shouldn’t eat or drink anything after midnight on the day before your test if you are advised not to. Make sure to arrive at the surgery site at the scheduled time.

After you check in, you will be taken to a private room or cubicle, where you will be asked to remove your clothing and jewelry and put on a hospital gown (it may be a good idea to leave jewelry at home to prevent loss). The nurse will then start an IV in your hand, wrist, or arm. You may feel a short, sharp pain when the nurse inserts the needle, but the discomfort will fade quickly. The nurse will tape the IV in place so that you don’t accidentally remove it.

When it’s 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’re in the operating room, you will lie on your back on the operating table. An anesthesiologist will then inject a medication into your IV that will put you into a deep sleep. You won’t feel pain during the procedure. Once you’re 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.

They’ll 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 stitch the incision closed. 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 can go home within a few hours.

Your throat will probably feel swollen and tender for a few days, and it may hurt to talk or 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 hemorrhage which can be fatal. This complication, however, is exceedingly rare.

When doctors look at the biopsies, 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, they will culture the tissue to identify the microorganisms present and select the best medications to treat it.