title: [Mediastinoscopy for diagnosis of diseases of the chest and staging of lung cancer: our experience in 253 cases].
abstract: The main indications for cervical mediastinoscopy are preoperative staging of lung cancer and diagnostic biopsy of mediastinal mass (lymphoma, sarcoidosis, tuberculosis etc.). We undertook a retrospective review of our experience of mediastinal exploration by cervical media-stinoscopy: 253 mediastinoscopies were performed on 252 patients (195 male and 57 female; mean age 53 years, range 14-88 years) between 1995 and June 2003. Four extended mediastinoscopies were performed and 1 patient had a re-mediastinoscopy following a non-diagnostic procedure. 319 lymph nodal stations were investigated in 253 procedures. We observed no mortality, while 2 patients had major bleeding (0.7%), with the need for open surgical treatment in order to achieve haemostasis. The median length of hospital-stay was one day, with discharge in the first postoperative day. 69 out of 170 patients, who eventually resulted to be affected by a histologically proven lung cancer, had a negative mediastinoscopy. Fifteen of them resulted N2 at the time of surgery: 8 patients with a false negativity in a biopsied station (4 in station 4R and 4 in station 7), while 7 cases showed infiltration in stations which were not sampled (5 in station 5, 1 in station 8 and 1 in station 7, the latter being the only one in which a standard cervical mediastincoscopy could have been able to stage it correctly). So, having observed 61 true negatives and 8 false-negatives in the sampled stations, in our experience the negative predictive value of cervical mediastinoscopy was 88.4%, with 78.2% of patients correctly staged without using other diagnostic tools. In conclusion, mediastinoscopy is an important procedure for the diagnostic biopsy of mediastinal mass and a useful tool in preoperative staging of lung cancer, especially if associated with chest CT-scan and Positron Emission Tomography (PET). In our experience, the spreading of PET does not lead to a reduction of cervical mediastinoscopies, both for the contemporary introduction of new chemotherapeutic preoperative protocols and, above all, for the not negligible incidence of false-positive results using PET, suggesting that media-stinoscopy should always be performed in patients affected by a PET-positive mediastinal growth.
authors.affiliation: Scuola di Specializzazione in Chirurgia Toracica, Università degli Studi di Verona.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scanagatta
authors.forename: Cinzia
authors.initials: C
authors.lastname: Bonadiman
authors.forename: Giovanni
authors.initials: G
authors.lastname: Falezza
authors.forename: Alberto
authors.initials: A
authors.lastname: Terzi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Magnanelli
authors.forename: Cristiano
authors.initials: C
authors.lastname: Benato
authors.forename: Birgit
authors.initials: B
authors.lastname: Feil
authors.forename: Irene
authors.initials: I
authors.lastname: Spilimbergo
authors.forename: Sonia
authors.initials: S
authors.lastname: Pergher
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lonardoni
authors.forename: Gaetano
authors.initials: G
authors.lastname: Furlan
authors.forename: Ettore
authors.initials: E
authors.lastname: Montresor
authors.forename: Francesco
authors.initials: F
authors.lastname: Calabrò
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008481:Mediastinoscopy / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies