Video-assisted cervical mediastinoscopy: our seven-year experience

Karfis, Elias; Roustanis, Evangelos; Beis, John; Kakadellis, John

doi:10.1510/icvts.2008.178111

Cited by 28 publications

(12 citation statements)

References 11 publications

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“…A diagnosis of sarcoidosis with conventional TBNA has been reported in 48%–82% of the cases, which is lower than that observed in the studies with EBUS-TBNA. 17 , 18 Garwood et al demonstrated that EBUS-TBNA of mediastinal/hilar lymph nodes may yield a granulomatous reaction in 85% of the patients suspicious of pulmonary sarcoidosis. 18 The presence of non-caseating granulomas on cytological examination, however, was not sufficient to diagnose sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

The role of mediastinoscopy in the diagnosis of non-lung cancer diseases

Onat

Ateş²,

Avcı

et al. 2017

TCRM

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BackgroundMediastinoscopy is a good method to evaluate mediastinal lesions. We sought to determine the current role of mediastinoscopy in the investigation of non-lung cancer patients with mediastinal lymphadenopathy.Materials and methodsWe retrospectively reviewed clinical parameters (age, gender, histological diagnosis, morbidity, mortality) of all patients without lung cancer who consecutively underwent mediastinoscopy in Hospital of Faculty of Medicine of Dicle University between June 2003 and December 2016.ResultsTwo-hundred twenty nine patients without lung cancer who underwent mediastinoscopy for the pathological evaluation of mediastinum during the study period were included. There were 156 female (68%) and 73 male (32%) patients. Mean age was 52.6 years (range, 16 to 85 years). Mean operative time was 41 minutes (range, 25 to 90 minutes). Mean number of biopsies was 9.3 (range, 5 to 24). Totally, 45 patients (19.6%) had previously undergone a nondiagnostic bronchoscopic biopsy such as transbronchial needle aspiration or endobronchial ultrasound-guided transbronchial needle aspiration. Mediastinoscopy was diagnostic for all patients. Diagnosis included sarcoidosis (n=100), tuberculous lymphadenitis (n=66), anthracosis lymphadenitis (n=44), lymphoma (n=11) metastatic carcinoma (n=5), and Castleman’s disease (n=1); there was a diagnosis of silicosis in one patient and tymoma in one patient. Neither operative mortality nor major complication developed. The only minor complication was wound infection which was detected in three patients.ConclusionAlthough newer diagnostic modalities are being increasingly used to diagnose mediastinal diseases, mediastinoscopy continues to be a reliable method for the investigation of mediastinal lesions.

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Section: Discussionmentioning

confidence: 99%

The role of mediastinoscopy in the diagnosis of non-lung cancer diseases

Onat

Ateş²,

Avcı

et al. 2017

TCRM

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“…Although only a small number of cases in this series underwent pulmonary resection after a negative VAM, there were no false negatives when the resected specimens from the routine lymphadenectomy at time of surgery were analysed. The number of patients included is small [2][3][4][5][6][7][8]. Major haemorrhagic complication requiring sternotomy is rare, but can by fatal [3].…”

Section: Commentsmentioning

confidence: 99%

Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy?

Zakkar

Tan

Hunt

2011

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether videoassisted mediastinoscopy (VAM) is a more effective procedure than conventional mediastinoscopy (CM). A total of 108 papers were identified using the search as discussed below. Of which, eight papers presented the best evidence to answer the clinical question as they included a sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates, number of lymph nodes biopsies, number of stations sampled and training opportunities were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. Literature search revealed that CM is a safe procedure associated with low mortality (0-0.05%) and morbidity (0-5.3%). CM has high levels of accuracy (83.8-97.2%) and negative predictive value (81-95.7%). Training in CM can be difficult as the limited vision means that the trainer cannot monitor directly the dissection and the areas biopsied by the trainee as one operator and effectively see at any time. VAM is also a safe procedure with comparable results to that of CM in term of mortality (0%), morbidity (0.83-2.9%), accuracy (87.9-98.9%) and negative predictive values (83-98.6%). The main advantage is higher number of biospsies taken (VAM, 6-8.5; CM, 5-7.13) and number of mediastinal lymph node stations sampled (VAM, 1.9-3.6; CM, 2.6-2.98). VAM can be associated with more aggressive dissecting and that can lead to more complications. The use of VAM can provide a better and safer training opportunity since both trainer and trainee can share the magnified image on the monitor. All studies available are comparing heterogeneous groups of non-matched group of patients which can bias the outcomes reported. There is a lack of comprehensive randomized studies to compare both procedures and to support any preference towards VAM over CM. We conclude that there is actually very little objective evidence of VAM superiority over CM.

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“…Its sensitivity is high (75-90%) and complications are rare, although potentially severe. 5, [38][39][40][41] However, it can only reach the paratracheal stations (levels one, two and four) and the subcarinal station (level seven, anterior). 5 In general, this technique is not popular among surgeons; 42 in addition, the increasing availability and accuracy of ultrasound-guided minimally invasive techniques have been challenging the reference role of mediastinoscopy in recent years.…”

Section: Surgical Techniquesmentioning

confidence: 99%

The Challenge of Mediastinal Staging

Ceron¹,

Michieletto²,

Zamperlin³

et al. 2011

European Oncology &Amp; Haematology

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Lung cancer staging is a crucial step in both correct prognosis and therapy. Mediastinal staging in particular is usually accomplished using imaging techniques such as computed tomography and 18Fglucose positron-emission tomography, minimally invasive techniques, i.e. transbronchial needle aspiration with or without ultrasound guidance (endobronchial ultrasound) and transoesophageal ultrasound-guided fine needle aspiration and surgical procedures, i.e. mediastinoscopy, thoracoscopy. Each of these techniques has its own sensitivities, specificities and predictive values that must be thoroughly considered within the staging route, with the aim of achieving the best result with the least resource consumption and the least discomfort to the patient; the correct evaluation of a negative result on the basis of its predictive value is essential as well. In this article we suggest a mathematical model that can predict the probability of nodal metastasis after a certain number of diagnostic procedures has been performed, providing an objective way of evaluating whether a patient is fit for surgery or, conversely, whether further investigations are required.

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Video-assisted cervical mediastinoscopy: our seven-year experience

Cited by 28 publications

References 11 publications

The role of mediastinoscopy in the diagnosis of non-lung cancer diseases

The role of mediastinoscopy in the diagnosis of non-lung cancer diseases

Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy?

The Challenge of Mediastinal Staging

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