Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study

To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients.

We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T).

There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p < 0.05). The overall morbidity was zero in group M and 4.8% in group T (p < 0.05).

The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.