title: Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate.
abstract: BACKGROUND
  Mediastinoscopy is a valuable tool for evaluating mediastinal pathology and is essential for establishing treatment strategies in most patients with lung cancer. We sought to determine the complication and false negative rate for mediastinoscopy in an institution that routinely performs this procedure.
  
  
  METHODS
  We performed a retrospective review of 2,145 consecutive mediastinoscopies at a single institution between April 1996 and April 2005. Demographics and complications were analyzed. In patients with lung cancer who underwent subsequent resection, the false negative rate was calculated.
  
  
  RESULTS
  Mean patient age was 61 +/- 0.4 years, and 58% (n = 1,253) were male. Pathology included lung cancer (n = 1,459), metastatic disease (n = 78), lymphoma (n = 51), and other benign disease (n = 557). Twenty-three patients (1.07%) experienced complications including hemorrhage (n = 7, 0.33%), vocal cord dysfunction (n = 12, 0.55%), tracheal injury (n = 2, 0.09%), and pneumothorax (n = 2, 0.09%). There was 1 death (0.05%) after pulmonary artery injury. Five of the 7 vascular injuries occurred during biopsy of level 4R. Three hundred and forty-three patients (23.5%) with lung cancer had positive mediastinoscopies. The false negative rate was 56 of 1,019 (5.5%) among lung cancer patients undergoing resection. Thirty-two (57%) of the false negatives were due to metastatic disease in lymph nodes not normally biopsied during cervical mediastinoscopy (levels 5, 6, 8, or 9).
  
  
  CONCLUSIONS
  Although invasive, mediastinoscopy identified locally advanced disease in a significant percentage of this lung cancer population and was associated with a low false negative rate. Complications after mediastinoscopy were uncommon. These results support the continued routine use of mediastinoscopy.
authors.affiliation: Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lemaire
authors.forename: Ivana
authors.initials: I
authors.lastname: Nikolic
authors.forename: Thomas
authors.initials: T
authors.lastname: Petersen
authors.forename: Jack C
authors.initials: JC
authors.lastname: Haney
authors.forename: Eric M
authors.initials: EM
authors.lastname: Toloza
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies