TECHNIQUE AND OUTCOMES OF STANDARD MEDIASTINOSCOPY

Technique and outcomes of customary mediastinoscopy
mediastinoscopy has been the moststay of invasive mediastinal
staging for the past forty years. the procedure is performed
within the operating room, typically beneath general anesthesia. it
is presently done as an outpatient in most u. s. centers. 7–9
mediastinoscopy involves an incision barely on top of the suprasternal
notch, insertion of a mediastinoscope alongside the trachea,
and biopsy of mediastinal nodes. rates of morbidity and mortality
as a results of this procedure are low ( 2% and zero. 08% ). 10
right and left high and low paratracheal nodes ( stations 2r,
2l, 4r, 4l ), pretracheal nodes ( stations one, three ), and anterior
subcarinal nodes ( station seven ) are accessible via this approach.
node teams which willnot be biopsied with this technique
embrace posterior subcarinal ( station seven ), inferior mediastinal
( stations eight, nine ), aortopulmonary window ( apw ) ( station five ),
and anterior mediastinal ( station half dozen ) nodes.
the average sensitivity of mediastinoscopy to detect
mediastinal node involvement from cancer could be approximately
80%, and therefore the average fn rate could be approximately 10% to 15%
( table 29. one ), as has been compiled in many systematic reviews.
five, 11 many authors have shown that approximately half
( 42% to 57% ) of the fn cases were caused by nodes that were
not accessible by the mediastinoscope. 12–17 the specificity
and therefore the fp rates of mediastinoscopy are reported to be 100%
and zero, respectively. strictly speaking, these values cannot
extremely be assessed as a result of patients with a positive biopsy were
not subjected to any more procedures ( e. g., thoracotomy ) to
confirm the results. the results of mediastinoscopy are fairly
consistent among studies.