Standard Cervical Mediastinoscopy in the Diagnosis of Mediastinal Masses

The present study is designated to clarify, indications, contraindications, complications, sensitivity, specificity of standard cervical mediastinoscopy to diagnose mediastinal lesions. Material and Methods: To validate our experience with standard cervical mediastinoscopy, I conducted this study on 65 patients between January 2000 and August 2003. Mediastinoscopy was indicated for diagnostic staging of nodal disease related to lung cancer in 21 patients (group I) or for isolated mediastinal lymphadenopathy in 44 patients (group II). Results: There were 43 males and 22 females, with a mean age of 37 years. The mean operative time was 28 minutes and the mean hospital stay was 15 hours. In lung cancer patients, a false negative result was obtained in one patient. In patients with isolated mediastinal lymphadenopathy, malignant lymphoma was the commonest diagnosis. Sarcoidosis was the next common. There was technical failure in obtaining biopsy in two patients early in the author's experience. There were two cases with surgery-related morbidity in the form of mild bleeding which was controlled by local diathermy coagulation. There was no surgery-related mortality. The sensitivity of standard cervical mediastinoscopy in this study was 97.8%, specificity 100%, PPV 100%, NPV 94.4% and total accuracy of 98.4%. Conclusion: Standard cervical mediastinoscopy is safe, cost effective, highly specific and is still the first investigation of choice in the diagnosis of mediastinal nodal involvement