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Mediastinoscopy

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Abstract

A CONSISTENT feature of malignant pulmonary neoplasms is their ultimate dissemination into the mediastinal lymphatics. Chest roentgenography may suggest mediastinal spread, but attempts to confirm this and thereby predict the probability of a curative resection have proved difficult short of thoracotomy. Scalene node biopsy, once thought to provide a basis for estimating operability, has turned out to be inefficient and unrewarding unless supraclavicular nodes are already palpable.

Mediastinoscopy, introduced in 1959,1 offers substantial aid to this dilemma in that pathologic lesions on both sides of the carina can be exposed for biopsy without resorting to thoracotomy. Although the procedure was initially intended for the detection of advanced bronchial carcinoma, our experience with 100 consecutive mediastinoscopies shows that it is a valuable method for diagnosing a wide variety of diseases that infiltrate the mediastinum.

Indications and description of procedure

Various thoracic lesions, inflammatory and neoplastic, can be investigated by means of mediastinoscopy. However, the following radiographic features offer the most favorable indications for this examination: (1) any lung mass other than the peripherally located solitary pulmonary nodule (a central or hilar lesion with roentgenographic or bronchoscopic evidence of mediastinal involvement should be evaluated by mediastinoscopy); (2) bronchial carcinoma in patients who manifest advanced signs (such as atelectasis, diaphragmatic or vocal cord paralysis, pleural effusions, or demonstrate bronchoscopic evidence of extrinsic tracheobronchial compression); (3) enlargement of the mediastinal shadow of unknown cause; and (4) suspected sarcoidosis.

When certain precautions are observed, mediastinoscopy is a remarkably straightforward and safe diagnostic approach and may . . .


 

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