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Mediastinoscopy, Its Variants and Transcervical Mediastinal Lymphadenectomy

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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, but there are other indications for invasive staging, such as central tumours larger than 3 cm or clinical N1 disease. In these two circumstances, the rate of identification of unsuspected mediastinal nodal disease can be as high as 22% and 40%, respectively. Sensitivity and negative predictive value of transcervical lymphadenectomies are close to 1. The European Society of Thoracic Surgeons and the American College of Chest Physicians recommend to pathologically confirm any mediastinal abnormality observed on computed tomography or positron emission tomography, as well as to indicate invasive staging in central tumours and when there is evidence of N1 disease. Mediastinoscopy and its variants should be used if endoscopies with fine-needle aspiration are negative.

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Authors and Affiliations

  1. Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain

    Ramón Rami-Porta

  2. Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain

    Ramón Rami-Porta

  3. Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Spain

    Sergi Call

  4. Department of Morphological Sciences, Medical School, Autonomous University of Barcelona, Bellaterra, Spain

    Sergi Call

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  1. Ramón Rami-Porta
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  1. Interventional Pulmonary Department Hospital, Universitari de Bellvitge Hospitalet de Llobregat, Barcelona, Spain

    José Pablo Díaz-Jiménez

  2. School of Medicine, National University of Mar del Plata, Buenos Aires, Argentina

    Alicia N. Rodríguez

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Rami-Porta, R., Call, S. (2023). Mediastinoscopy, Its Variants and Transcervical Mediastinal Lymphadenectomy. In: Díaz-Jiménez, J.P., Rodríguez, A.N. (eds) Interventions in Pulmonary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-22610-6_27

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