Mediastinoscopy in advanced superior vena cava obstruction

Superior vena cava syndrome can be a rapidly progressive, lethal process that is caused by a malignancy in 92 to 94% of cases. Since all effective therapy is inherently harmful, it would be reassuring to have a definitive tissue diagnosis before initiating treatment. Because easily accessible tissue is not always available, mediastinoscopy must be relied on to confirm the diagnosis in some patients. Twenty-nine patients with advanced superior vena cava syndrome were reviewed. Fifteen of them required mediastinoscopy to confirm the diagnosis, since lesser procedures, i.e., bronchoscopy, needle biopsy, and sputum cytology, were negative for malignant tissue. Contrary to reports in the literature, mediastinoscopy can be performed safely in patients with advanced superior vena cava syndrome and can yield a definitive diagnosis in each.