THORACOSCOPIC MEDIASTINAL LYMPH-NODE SAMPLING - USEFUL FOR MEDIASTINAL LYMPH-NODE STATIONS INACCESSIBLE BY CERVICAL MEDIASTINOSCOPY

Cervical mediastinoscopy is useful for the diagnosis of paratracheal l ymph node metastasis from bronchogenic carcinoma. Access to adenopathy in the aorticopulmonary window, anterior mediastinal, periazygos, and subcarinal lymph nodes is difficult with this technique. Operative vi sibility in these locations through anterior mediastinotomy, the Chamb erlain procedure, is limited. We have used thoracoscopic mediastinal e xploration in 40 patients with computed tomographic scan evidence of e nlarged aorticopulmonary window (n = 30) or enlarged right periazygos or subcarinal lymph nodes (n = 10). This procedure was used primarily as an adjunct to cervical mediastinoscopy in the staging of bronchogen ic carcinoma. Adjunctive thoracoscopic nodal sampling was 100% sensiti ve and 100% specific in diagnosing the mediastinal adenopathy. It did not significantly delay thoracotomy in cases of benign adenopathy. Vis ibility of the ipsilateral pleural space and mediastinum was excellent . Thoracoscopic exploration with mediastinal nodal sampling is a valua ble diagnostic adjunct for assessment of adenopathy inaccessible to ce rvical mediastinoscopy and can overcome many of the limitations of ant erior mediastinotomy.