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Mediastinoscopy and Its Variants

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Interventions in Pulmonary Medicine

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Abstract

Mediastinoscopy explores the upper mediastinum and reaches the lymph nodes of the sternal notch, the superior and inferior, left and right, paratracheal nodes, the subcarinal nodes and the right and left hilar nodes. It is also useful to assess direct invasion of the mediastinum by the primary tumour. Its sensitivity, negative predictive value and accuracy generally are around 0.9 or greater. Complication rate ranges from below 1 % to 3.7 %, and mortality is below 0.5 %. Left parasternal mediastinotomy and extended cervical mediastinoscopy reach the subaortic and para-aortic nodes and are a good complement to mediastinoscopy for staging left lung cancers. For extended cervical mediastinoscopy, sensitivity ranges from 0.69 to 0.81; negative predictive value, from 0.89 to 0.97; and accuracy, from 0.91 to 0.98. Transcervical mediastinal lymphadenectomies are especially indicated when the mediastinum is normal on computed tomography and positron emission tomography. The European Society of Thoracic Surgeons and the American College of Chest Physicians recommend to pathologically confirm any abnormality observed on computed tomography and positron emission tomography, and mediastinoscopy and its variants should be used if endoscopies with fine needle aspiration are negative.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, 5 Plaza Dr. Robert, Terrassa, Barcelona, Spain

    Ramón Rami-Porta M.D., Ph.D., F.E.T.C.S. & Sergi Call M.D., F.E.T.C.S.

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  1. Ramón Rami-Porta M.D., Ph.D., F.E.T.C.S.
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  2. Sergi Call M.D., F.E.T.C.S.
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Correspondence to Ramón Rami-Porta M.D., Ph.D., F.E.T.C.S. .

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  1. MD Anderson Cancer Center, Houston, TX, Department of Pulmonary Medicine, Bellvitge University Hospital, Barcelona, 08907, Spain

    Jose Pablo Díaz-Jimenez

  2. Clinica Y Maternidad Colon, Pulmonary Department, Mar Del Plata, Buenos Aires, 7600, Argentina

    Alicia N. Rodriguez

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Rami-Porta, R., Call, S. (2013). Mediastinoscopy and Its Variants. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6009-1_20

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