The risk of tumor cell dissemination in mediastinoscopy: a cytological study

Abstract

Background/aim: Mediastinoscopy is an invasive procedure that is used in the diagnosis of mediastinal diseases and in staging lung cancer. Tumor cell seeding during mediastinoscopy along the mediastinum and the incision line is a very rare complication. This study aimed to test the safety of mediastinoscopy in terms of tumor seeding by cytological evaluation of mediastinal lavage samples taken before and after biopsy. Materials and methods:The patients who underwent mediastinoscopy in our hospital between 2011 and 2014 were studied prospectively. Seventy-three patients with a diagnosis of lung or mediastinal malignancy were included in the study. All patients underwent classical cervical mediastinoscopy and mediastinal lavages were taken before and after the biopsy. Both lavage samples were sent to the pathology department in syringes for malignant cell cytology screening. Results:The results of the histopathological examinations of lymph node biopsies were reactive in 25 patients and positive for malignancy in 48 patients. In 2 of 48 patients whose lymph nodes were reported to be positive for malignancy, the mediastinal lavage sample was reported to be positive for malignancy after biopsy, although it was negative preoperatively. In two patients, both the pre-and postbiopsy lavage samples were reported to be positive for malignancy. Conclusion:While performing dissection and biopsy during mediastinoscopy, tumor seeding into the mediastinum may occur. Long follow-up periods and large patient series are needed to determine how cytopathological examination of both fluids would affect the prognosis.

The risk of tuberculosis bacilli seeding during mediastinoscopy in mediastinal tuberculosis: Is it clinically important?

“…This can also lead to delays in the initiation of treatment. For this reason, the diagnostic value of mediastinoscopy increases further, especially in non-cancer, mediastinal pathologies (6,18). This study has some limitations.…”

“…Reported morbidity and mortality rates for mediastinoscopy are 0.08% and 0%, respectively. Severe bleeding, tracheobronchial laceration, esophageal perforation, recurrent and phrenic nerve paralysis, thoracic duct injury, mediastinitis, venous air embolism and tumor cell seeding in the mediastinum and along the incision line are major complications that can accompany mediastinoscopy (6). However, there is no available information about the seeding of tuberculosis bacilli in the mediastinum during mediastinoscopy and its effects on the treatment process of tuberculosis.…”

Successful experience of simultaneous video-assisted mediastinal lymphadenectomy and videothoracoscopic sleeve lobectomy for central cancer of the left lung

“…Однако эта методика не лишена недостатков, таких как невозможность использования второго инструмента из-за узости канала медиастиноскопа, фрагментация лимфатических узлов во время удаления, риск диссеминации опухолевых клеток и т. п. [13,14]. Появление миниинвазивных доступов для подобных вмешательств, лишенных этих недостатков, разработка методик расширенной чрезшейной медиастинальной лимфаденкэтомии (TEMLA -transcervical extended mediastinjscopic lymphadenectomy) и видеоассистированной медиастинальной лимфаденэктомии (VAMLA -video-assisted mediastinoscopic lymphadenectomy) открыла новую страницу в истории хирургии рака легкого [15,16].…”

CT-guided biopsy of the mediastinal masses. Can anatomical relationships predict complications?

“…This procedure can be used in some indicated cases 13 . The complications of surgical modalities are not common, but they are serious [14][15][16] .…”