ROLE OF MEDIASTINOSCOPY IN SUPERIOR VENA-CAVA OBSTRUCTION

Background. The role of mediastinoscopy in superior vena cava obstruct ion (SVCO) is not clearly defined. The authors set out to examine the efficacy and safety of mediastinoscopy in SVCO. Methods. They reviewed 14 patients referred to one surgical team over an 8-year period (1982 -1990) who required mediastinoscopy to establish a histologic diagnosi s after other less invasive procedures had not established the diagnos is. Results. Of the 14 patients, 11 had lung cancer, 2 had lymphoma, a nd 1 had malignant thymoma. Definitive tissue diagnosis was obtained i n 13 cases. Mediastinoscopy was unsuccessful in one of the cases becau se no pathologic tissue could be identified at the time of the procedu re. Tissue diagnosis could only be obtained in this patient after medi astinotomy, and a lymphoma was found. There was one complication of me diastinoscopy; one patient had arterial bleeding from the innominate a rtery that required limited sternotomy to control the bleeding. Conclu sions. The authors believe that mediastinoscopy is a safe and effectiv e technique for establishing a histologic diagnosis in SVCO when less invasive techniques have been unsuccessful. The use of blind radiation therapy cannot be justified on an emergency basis; failure to obtain a histologic diagnosis will result in up to 20% of patients receiving inappropriate radiation therapy, making subsequent tissue diagnosis ve ry difficult.