The current role of mediastinoscopy in the evaluation of thoracic disease

Objective: Mediastinoscopy is a common procedure used for the diagnosis of thoracic disease and the staging of Lung cancer, We sought to determine the current role of mediastinoscopy in the evaluation of thoracic disease. Met hods: We conducted a retrospective review of all mediastinoscopies performe d by members of our service between January 1988 and September 1998, Result s: We performed mediastinoscopies on 2137 patients. A total of 1745 patient s underwent mediastinoscopy for known or suspected lung cancer. In 422 of t hese procedures, N2 or N3 disease was identified; only 28 of these patients underwent resection, The remaining 1323 had no evidence of metastatic dise ase, In these patients 947 had lung cancer. Only 76 of the patients with lu ng cancer were found to have N2 disease at exploration. Among the 1323 pati ents with a negative mediastinoscopy result, 52 underwent resection of a no n-bronchogenic malignancy, and 217 had resection of a benign lesion. A tota l of 392 patients underwent mediastinoscopy for the evaluation of mediastin al adenopathy in the absence of any identifiable pulmonary lesion, Of these , 161 had a nonbronchogenic malignancy, 209 had benign disease, and 25 had no diagnosis established; mediastinoscopy established a definitive diagnosi s in 93.6% of patients. In the entire group of 2137 patients, there were 4 perioperative deaths and 12 complications, Only one death was directly attr ibuted to mediastinoscopy, No deaths or complications occurred in patients undergoing mediastinoscopy for benign disease. Conclusions: Mediastinoscopy is a highly effective and safe procedure. We believe that mediastinoscopy should currently be used routinely in the diagnosis and staging of thoracic diseases.