Diagnosis of mediastinal masses in pediatric patients using mediastinoscopy and the Chamberlain procedure

Background/Purpose: Mediastinal masses commonly are referred to the pediatr ic surgeon and can be difficult diagnostic problems. Various techniques hav e been used to perform biopsy in the mediastinum, but there are few reports of mediastinoscopy or Chamberlain procedure in children in the literature. The authors reviewed their experience with these techniques in a pediatric oncology population. Methods: The medical records of all patients on the pediatric surgical serv ice between 1987 and 1997, inclusive, who underwent mediastinoscopy or Cham berlain procedure were reviewed. Demographic data, diagnostic accuracy, com plications, operating time, and blood loss were recorded. Results: Sixteen consecutive patients underwent 13 Chamberlain procedures a nd six mediastinoscopies over the above period. Diagnostic accuracy was fou nd to be 95% overall (100% for Chamberlain procedure, 83% for mediastinosco py). Five complications occurred in the Chamberlain group and none in the m ediastinoscopy group. No complication required thoracotomy or sternotomy. A mong patients whose sole reason for admission was diagnosis of a mediastina l mass, the mean hospital stay was 1.7 +/- 0.8 days (n = 7) for those who u nderwent Chamberlain procedure and 1.4 +/- 0.9 days (n = 4) for those who u nderwent mediastinoscopy. One mediastinoscopy was performed as an ambulator y procedure. Conclusion: Mediastinoscopy and the Chamberlain procedure are effective and safe techniques for biopsy of mediastinal masses in this age group. (C) 19 99 by W.B. Saunders Company.