Videomediastinoscopy for the diagnosis of the diseases of the lung and mediastinum.
BACKGROUND
The biopsy of the mediastinum by mediastinoscopy is established as the most accurate method especially in the lung cancer staging, but helps also in the diagnosis of various diseases of the lung and mediastinum. The videomediastinoscopic equipment offers more precise procedure and shorter learning curve in comparison with classical technique due to the sharing of the procedure with other (more experienced) surgeon. The aim of our work was to confirm the safety and reliability of the videomediastionoscopy in our department, where the use of the traditional technique was exceptional.


METHODS
Patients with expansion in the mediastinum (or enlargement of the mediastinal lymph nodes) of the unknown aetiology accessible by videomediastinoscopy according to CT were included. Standard videomediastinoscopic technique was used. The attempt to take biopsy of the mediastinal tumor and/or the lymph nodes in stations 1, 2, 4, 7 according the UICC regional lymph node mapping was done.


RESULTS
There were 126 patients operated by videomediastinoscopy between January 1998 and June 2003. There were 83 men with a mean age of 50.43 years (range 14 to 78 years) and 43 women with a mean age of 50.79 years (range 18 to 77 years). The diagnosis defined by explicit morphology was made in 95 cases (75.40%). In 25 cases (19.84%) the result of the biopsy was either normal lymphatic tissue or slight inflammatory changes. In three cases (2.38%) the pathologist expressed strong suspicion of the malignant disease, without clear morphology. In two cases (1.59%) all tissue samples were completely necrotic. No biopsy was done once (0.77%). There were four major groups of patients with positive histology: Patients with sarcoidosis, patients with metastases of the epithelial malignity to the mediastinal lymph nodes, patients with lymphoma and the group containing patients with a diagnosis of a low frequency (tuberculosis, sarcoma, Castleman's disease and others). No mortality was related to the procedure. We had one serious surgical complication: bleeding from the right innominate artery successfully treated by suture.


CONCLUSIONS
Videomediastinoscopy is a safe and accurate method with a short learning curve. The key point of the diagnostic success is a proper indication for the procedure. Videomediastinoscopic equipment and its use is to be recommend to each department of general thoracic surgery.
Jedlicka
V
V
First Department of Surgery, St. Anna University Hospital, Pekarska 53, Brno 656 91, Czech Republic. vjedlic@med.muni.cz
Capov
I
I
Pestal
A
A
Stasek
T
T
Dolezel
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis*; D008175:Lung Neoplasms / Q000175:diagnosis; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis*; D008481:Mediastinoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis; D020775:Thoracic Surgery, Video-Assisted