Selective mediastinoscopy

Mediastinoscopy is often utilized for staging bronchogenic carcinoma. Whether it should be used routinely or selectively is controversial. Fifty-four patients with bronchogenic carcinoma were prospectively assigned to one of two groups based on the presence (group A) or absence (group B) of one or more of the following criteria: (1) central location; (2) mediastinal nodal enlargement; (3) involvement of laryngeal nerve; and (4) noncentral location plus linear stranding toward the hilum. Mediastinoscopy was performed on all patients in group A. Thoractomy for definitive staging was performed on those patients in group A with negative mediastinoscopic findings for neoplasm and on all patients in group B. Criteria 1, 2, and 3 were found to be valid; 22 of the 27 patients in group A who had any of these criteria had positive mediastinoscopic findings for neoplasm. Criterion 4 per se was found to be invalif; all seven of the patients in group A who had this isolated finding had negative mediastinoscopic findings for neoplasm and had resectable lesions. Twenty-three of the 27 patients in group B had no mediastinal involvement and had resectable lesions. These data indicate that selective mediastinoscopy using criteria 1 through 3 reduces the number of negative examinations and unnecessary thoracotomies to a minimum.