[The comprehensive diagnosis of lesions of the intrathoracic lymph nodes]

The paper deals with results of complex diagnosis of intrathoracic lymph node involvement in 194 patients with malignant lymphoma (85 cases), cancer (11), sarcoidosis (95) or lymphadenitis (3 cases). All the patients underwent complex roentgenologic and radionuclide examination. Tumor tissue sampling aimed at morphologic verification was carried out by transthoracic puncture, mediastinoscopy, parasternal mediastinotomy or diagnostic thoracotomy. The following diagnostic algorithm was suggested: in patients with involvement of the anterior mediastinum, diagnosis should start with transthoracic puncture (efficacy--71%) which should be followed, if it fails, by parasternal mediastinotomy (100%). Mediastinoscopy proved the best procedure for diagnosing central mediastinal lymph node involvement (efficacy--96%). Patients with lymphadenopathy in the anterior central mediastinum should undergo mediastinoscopy (efficacy--67%) or parasternal mediastinotomy (90%). Diagnostic thoracotomy was performed in 7 (3.6%) patients in whom the other methods had failed.