EXTENDED CERVICAL MEDIASTINOSCOPY - PROSPECTIVE-STUDY OF 50 CASES

To assess the usefulness of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma, an ECM was performed prospecti vely in 50 patients with bronchogenic carcinoma of the left lung. The ECM was used after evaluation of disease operability and computed tomo graphic findings, and was performed simultaneously with standard cervi cal mediastinoscopy. In ECM, using the same cervical incision as in a standard cervical mediastinoscopy, dissection is performed behind the anterior face of the sternum. The aortic arch is reached at the level of the origin of the innominate artery. The mediastinoscope is then pa ssed by sliding it along the left anterolateral face of the aortic arc h until it reaches the aortopulmonary window. Extended cervical medias tinoscopy was considered positive when a nodal biopsy result consisten t with a neoformative process or direct invasion of the mediastinal st ructures was found. Four patients with positive standard cervical medi astinoscopy and negative ECM were excluded. A false negative ECM was d efined as the presence of infiltrated adenopathies at the paraaortic l evel detected on postoperative histologic study. The ECM was positive in 5 patients in whom operation was contraindicated. Resectability in the remaining 41 patients was 97.6%. Postoperative pathologic study sh owed infiltrated adenopathy in 3 patients (2 subcarinal, 1 subaortic) accounting for 40 true negatives (the subcarinal group is inaccessible by ECM). This study suggests that ECM has outstanding specificity (10 0%), sensitivity of 83.3%, and a diagnostic accuracy of 97.8%. A posit ive predictive value of 100% and a negative predictive value of 97.5% were also identified by this study. We conclude that ECM is a useful t echnique to assess involvement of the aortopulmonary window in the pre operative staging of bronchogenic carcinoma of the left lung.