THE ROLE OF MEDIASTINOSCOPY IN THE DIAGNOSIS OF MEDIASTINAL LYMPHADENOPATHY

Objective: The reported experience of axial mediastinoscopy (MDS) perf ormed in a diagnostic purpose only (rather than prognostic) is limited . Therefore. we designated the present study to clarify morbidity, sen sitivity and accuracy of MDS performed to diagnose various mediastinal lesions. Methods: We prospectively performed 400 MDS in a diagnostic purpose on 398 patients for: (1) isolated mediastinal adenopathies in 271 patients (group 1), and (2) mediastinal adenopathies associated wi th a pulmonary or a hilar lesion of unknown aetiology in 127 patients (group 2). In group 1, most of the patients were suspected to have a s arcoidosis, a tuberculosis or a lymphoma. In group 2, most of the pati ents were suspected to have a lung cancer. In both groups, the other c urrent diagnostic procedure usually used in each pathology had failed to give an accurate diagnosis. Results: A total of 76% of the samples were performed in the right laterotracheal lymph node station, 12.5% i n the lower subcarinal and superior subcarinal lymph node station and 7.8% in the left laterotracheal lymph node station. The per- and pest- operative mortality rates were nil. The per-operative morbidity accoun ted for sis cases (1.5% of the examinations). The post-operative morbi dity accounted for, three cases (0.75% of the examinations). MDS data radically modified the pre-operative suspected diagnosis in 74 patient s (18.5% of the patients). There were 17 false negative results (4.3% of the patients). The global sensitivity of MDS was 94%, the global sp ecificity was 100% and the accuracy was 95%. In group 1, the sensitivi ty was 96% and in group 2 it was 92%. Conclusion: According to the res ults, the few contraindications of the procedure and its low cost, we confirm that MDS is still the first choice procedure to diagnose lesio ns located in the axial mediastinum. (C) 1998 Elsevier Science B.V. Al l rights reserved.