Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma

Background. Extended cervical mediastinoscopy (ECM) is a technique in the s taging of bronchogenic carcinoma described first by Ginsberg in 1984. To up date our experience we have prospectively evaluated our results on 106 pati ents who underwent the technique from 1985 to 1998. Methods. The ECM technique is performed once the operability of the patient has been evaluated, according to the computed tomography findings. The int ervention is carried out at the same time as a standard cervical mediastino scopy through the same incision following the same technique as previously published. The ECM is considered positive when metastatic nodes or tumor involvement d irectly in the paraaortic or subaortic regions is detected and confirmed hi stologically. Negative cases of ECM and positive cases of standard cervical mediastinoscopy are excluded from this study. A false-negative ECM is defi ned as the presence of infiltrated adenopathies at the paraortic level dete cted on postoperative histologic study. Results. We had performed ECM in 106 patients, and a total of 13 were subse quently excluded for the reasons stated above. Of the remaining cases, 26 w ere positive, 61 negative and 6 had false-negative results with no false-po sitive results. Sensitivity was 81.2%, specificity 100%, accuracy 93.3%, po sitive predictive value 100%, and negative predictive value 91%. There were no complications with the technique. Conclusions. We conclude that ECM is a useful technique for staging broncho genic carcinoma that allows samples to be taken from paraortic and subaorti c regions with minimally invasive techniques. (Ann Thorac Surg 2000;70:1641 -3) (C) 2000 by The Society of Thoracic Surgeons.