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Mediastinoscopy and Its Variants

  • Ramón Rami-Porta
  • Sergi Call
Chapter

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.

Keywords

Main Bronchus Bronchial Artery Recurrent Laryngeal Nerve Palsy Innominate Artery Azygos Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryHospital Universitari Mútua Terrassa, University of BarcelonaTerrassaSpain

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