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Mediastinoscopy

Mediastinoscopy

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the sternum (breastbone) that lies between the lungs. The organs in the mediastinum include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer. It is also ordered to detect infection, and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal (within the trachea) tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.


Purpose

Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma, including Hodgkin's disease. The diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. Lung cancer staging involves a determination of the level or progression of the cancer into stages. These stages help a physician study cancer and provide consistent cancer definition levels and corresponding treatments. They also provide some guidance as to prognosis. The lymph nodes in the mediastinum are likely to reveal if lung cancer has spread beyond the lungs. Mediastinoscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes indicates the diagnosis and stage of lung cancer.

Mediastinoscopy may also be ordered to verify a diagnosis that was not clearly confirmed by other methods, such as certain radiographic and laboratory studies. Mediastinoscopy may aid in some surgical biopsies of nodes or cancerous tissue in the mediastinum. In fact, a surgeon may immediately perform a surgical procedure if a malignant tumor is confirmed while the patient is undergoing mediastinoscopy. In these cases, the diagnostic exam and surgical procedure are combined into one operation.

Mediastinoscopy provides a diagnosis in 1075% of cases, depending on histology, location, and size of cancer. The false positive rate, however can be as high as 20%.

Demographics

Approximately 130,000 new pulmonary nodules are diagnosed each year in the United States. Of those, half are malignant. The majority of pulmonary nodules are diagnosed via mediastinoscopy.


Description

Mediastinoscopy is usually performed in a hospital under general anesthesia. Before the general anesthesia is administered, local anesthesia is applied to the throat while an endotracheal tube is inserted. Once the patient is under general anesthesia, a small incision is made, usually just below the neck or at the notch at the top of the sternum. The surgeon may clear a path and feel the person's lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician inserts the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light that allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform biopsies. A tissue sample from the lymph nodes or a mass can be removed and sent for study under a microscope, or to a laboratory for further testing.

In some cases, tissue sample analysis that shows malignancy will suggest the need for immediate surgery while the person is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue removal, and stitch the small incision closed. The person will remain in the surgerical recovery area until the effects of anesthesia have lessened and it is safe to leave the area. The entire procedure should require about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a safe, thorough, and cost-effective diagnostic tool with less risk than some other procedures.


Diagnosis/Preparation

Because mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Individuals who previously had mediastinoscopy should not receive it again if there is scarring from the first exam.

Several other medical conditions, such as impaired cerebral circulation, obstruction or distortion of the upper airway, or thoracic aortic aneurysm (abnormal dilation of the thoracic aorta) may also preclude mediastinoscopy. Certain structures in a person's anatomy that can be compressed by the mediastinoscope may complicate these pre-existing medical conditions.

Patients are asked to sign a consent form after reviewing the risks of mediastinoscopy and known risks and reactions to anesthesia. The physician will normally instruct the patient to fast from midnight before the test until after the procedure is completed. A physician may also prescribe a sedative the night before the exam and again before the procedure. Often a local anesthetic will be applied to the throat to prevent discomfort during placement of the endotracheal tube.


Aftercare

Following mediastinoscopy, patients will be carefully monitored and watched for changes in vital signs , or symptoms of complications from the procedure or anesthesia. The patient may have a sore throat from the endotracheal tube, experience temporary chest pain, and have soreness or tenderness at the incision site.


Risks

Complications from the actual mediastinoscopy procedure are relatively rare. The overall complication rates in various studies have been reported in the range of 1.33%. However, the following complications, in decreasing order of frequency, have been reported:

  • hemorrhage
  • pneumothorax (air in the pleural space)
  • recurrent laryngeal nerve injury, causing hoarseness
  • infection
  • tumor implantation in the wound
  • phrenic nerve injury (injury to a thoracic nerve)
  • esophageal injury
  • chylothorax (chyle is milky lymphatic fluid in the pleural space)
  • air embolism (air bubble)
  • transient hemiparesis (paralysis on one side of the body)

The usual risks associated with general anesthesia also apply to this procedure.


Normal results

In the majority of procedures performed to diagnose cancer, a normal result indicates the presence of small, smooth lymph nodes, and no abnormal tissue, growths, or signs of infection. In the case of lung cancer staging, results are related to the severity and progression of the cancer.


Morbidity and mortality rates

Abnormal findings may indicate lung cancer, tuberculosis, the spread of disease from one body part to another, sarcoidosis (a disease that causes nodules, usually affecting the lungs), lymphoma (abnormalities in the lymph tissues), and Hodgkin's disease.

Complications of mediastinoscopy include bleeding, pain, and post-procedure infection. These are relatively uncommon. Mortality is extremely rare.


Alternatives

A less invasive technique is ultrasound. However, it is not as specific as mediastinoscopy, and the information obtained is not as useful in making a diagnosis.

Although still performed, there is a decline in the use of mediastinoscopy as a result of advancements in computed tomography (CT), magnetic resonance imaging (MRI), and ultrosonography techniques. In addition, improved fine-needle aspiration (withdrawing fluid using suction) results of and core-needle biopsy (using a needle to obtain a small tissue sample) investigations, along with new techniques in thoracoscopy (examination of the thoracic cavity with a lighted instrument called a thoracoscope) offer additional options in examining masses in the mediastinum. Mediastinoscopy may be required when other methods cannot be used or when they provide inconclusive results.

See also Lung biopsy; Thoracic surgery.


Resources

books

Bland, K.I., W.G. Cioffi, M.G. Sarr, Practice of General Surgery. Philadelphia: Saunders, 2001.

Fischbach, F. and F. Talaska A Manual of Laboratory and Diagnostic Tests 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Grace, P.A., A. Cuschieri, D. Rowley, N. Borley, A. Darzi Clinical Surgery 2nd Edition. London: Blackwell Publishing, 2003.

Schwartz, S.I., J.E. Fischer, F.C. Spencer, G.T. Shires, J.M. Daly, J.M. Principles of Surgery 7th edition. New York: McGraw Hill, 1998.

Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, D.C. Sabiston Sabiston's Review of Surgery 3rd Edition. Philadelphia: Saunders, 2001.


periodicals

Beadsmoore C.J., N.J. Screaton. "Classification, Ttaging and Prognosis of Lung Cancer." European Journal of Radiology 45(1) (2003): 817.

Choi, Y.S., Y.M. Shim, J. Kim, K. Kim. "Mediastinoscopy in Patients with Clinical Ctage I Non-small Cell Lung Cancer." Annals of Thoracic Surgery 75(2) (2003): 3646.

Detterbeck, F.C., M.M. DeCamp, Jr., L.J. Kohman, G.A. Silvestri. "Lung cancer. Invasive staging: the guidelines." Chest 123(1 Suppl) (2003): 167S175S.

Falcone F., F. Fois, D. Grosso. "Endobronchial Ultrasound." Respiration 70(2) (2003): 17994.

Sterman, D.H., E. Sztejman, E. Rodriguez, J. Friedberg. "Diagnosis and Staging of 'Other Bronchial Tumors'." Chest Surgery Clinics of North America 13(1) (2003): 7994.


organizations

American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000, fax: 215-563-5718. <http://www.absurgery.org>.

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345, <http://www.cancer.org> .

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000, fax: (312) 202-5001. <[email protected]>. <http://www.facs.org>.

American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) 586-4872. <http://www.lungusa.org>.

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000, <http://www.ama-assn.org>.

Society of Thoracic Surgeons. 633 N. Saint Clair St., Suite 2320, Chicago, IL 60611-3658. (312) 202-5800, fax: 312-202-5801. <[email protected]>. <http://www.sts.org>.


other

Creighton University School of Medicine [cited May 14, 2003]. <http://medicine.creighton.edu/forpatients/mediast/mediastin.html>.

Harvard University Medical School [cited May 14, 2003]. <http://www.health.harvard.edu/fhg/diagnostics/mediastinoscopy/mediastinoscopy.shtml>.

Merck Manual [cited May 14, 2003]. <http://www.merck.com/pubs/mmanual/section6/chapter65/65i.htm>.

University of Missouri [cited May 14, 2003]. <http://www.ellisfischel.org/thoracic/testing/mediastinoscopy.shtml>.


L. Fleming Fallon, Jr., M.D., Dr.PH.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


A mediastinoscopy procedure is usually performed by a thoracic or general surgeon in a hospital setting.

QUESTIONS TO ASK THE DOCTOR


  • Why is this test needed?
  • Is the test dangerous?
  • What test preparation is required?
  • How long will the test take?
  • When will the results be available?
  • What form of anesthesia will be used?
  • Is the surgeon board certified?
  • How many mediastinoscopy procedures has the surgeon performed?
  • What is the surgeon's complication rate?

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"Mediastinoscopy." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Retrieved September 20, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy

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Mediastinoscopy

Mediastinoscopy

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the breastbone that lies between the lungs. The organs in the mediastinum include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer. It is also ordered to detect infection, and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal (within the trachea) tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.

Purpose

Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma , including Hodgkin's disease . The diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. Lung cancer staging involves the placement of the cancer's progression into stages, or levels. These stages help a physician study cancer and provide consistent definition levels of cancer and corresponding treatments. The lymph nodes in the mediastinum are likely to show if lung cancer has spread beyond the lungs. Mediastinoscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes indicates diagnosis and stages of lung cancer.

Mediastinoscopy may also be ordered to verify a diagnosis that was not clearly confirmed by other methods, such as certain radiographic and laboratory studies. Mediastinoscopy may also aid in certain surgical biopsies of nodes or cancerous tissue in the mediastinum. In fact, the surgeon may immediately perform a surgical procedure if a malignant tumor is confirmed while the patient is undergoing mediastinoscopy, thus combining the diagnostic exam and surgical procedure into one operation when possible.

Although still performed in 2001, advancements in computed tomography (CT) and magnetic resonance imaging (MRI) techniques, as well as the new developments in ultrasonography , have led to a decline in the use of mediastinoscopy. In addition, better results of fine-needle aspiration (drawing out fluid by suction) and core-needle biopsy (using a needle to obtain a small tissue sample) investigations, along with new techniques in thoracoscopy (examination of the thoracic cavity with a lighted instrument called a thoracoscope) offer additional options in examining mediastinal masses. Mediastinoscopy may be required, however, when these other methods cannot be used or when the results they provide are inconclusive.

Precautions

Because mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Patients who previously had mediastinoscopy should not receive it again if there is scarring present from the first exam.

Several other medical conditions, such as impaired cerebral circulation, obstruction or distortion of the upper airway, or thoracic aortic aneurysm (abnormal dilation of the thoracic aorta) may also preclude mediastinoscopy. Anatomic structures that can be compressed by the mediastinoscope may complicate these pre-existing medical conditions.

Description

Mediastinoscopy is usually performed in a hospital under general anesthesia. An endotracheal tube is inserted first, after local anesthesia is applied to the throat. Once the patient is under general anesthesia, a small incision is made usually just below the neck or at the notch at the top of the breastbone. The surgeon may clear a path and feel the patient's lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician will insert the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light that allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform biopsies. A sample of tissue from the lymph nodes or a mass can be extracted and sent for study under a microscope or on to a laboratory for further testing.

In some cases, analysis of the tissue sample which shows malignancy will suggest the need for immediate surgery while the patient is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue extraction and stitch the small incision closed. The patient will remain in the surgery recovery area until it is determined that the effects of anesthesia have lessened and it is safe for the patient to leave the area. The entire procedure should take about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a safe, thorough, and cost-effective diagnostic tool with less risk than some other procedures.

Preparation

Patients are asked to sign a consent form after having reviewed the risks of mediastinoscopy and known risks or reactions to anesthesia. The physician will normally instruct the patient to fast from midnight before the test until after the procedure is completed. A physician may also prescribe a sedative the night before the exam and before the procedure. Often a local anesthetic will be applied to the throat to prevent discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored to watch for changes in vital signs or indications of complications of the procedure or the anesthesia. A patient may have a sore throat from the endotracheal tube, temporary chest pain, and soreness or tenderness at the site of incision.

Risks

Complications from the actual mediastinoscopy procedure are relatively rarethe overall complication rate in various studies has been 1.3-3.0%. However, the following complications, in decreasing order of frequency, have been reported:

  • hemorrhage
  • pneumothorax (air in the pleural space)
  • recurrent laryngeal nerve injury, causing hoarseness
  • infection
  • tumor implantation in the wound
  • phrenic nerve injury (injury to a thoracic nerve)
  • esophageal injury
  • chylothorax (chylea milky lymphatic fluidin the pleural space)
  • air embolism (air bubble)
  • transient hemiparesis (paralysis on one side of the body)

The usual risks associated with general anesthesia also apply to this procedure.

Normal results

In the majority of procedures performed to diagnose cancer, a normal result involves evidence of small, smooth, normal-appearing lymph nodes and no abnormal tissue, growths, or signs of infection. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

Abnormal results

Abnormal findings may indicate lung cancer, tuberculosis, the spread of disease from one body part to another, sarcoidosis (a disease that causes nodules, usually affecting the lungs), lymphoma (abnormalities in the lymph tissues), and Hodgkin's disease.

Resources

BOOKS

Fischbach, Frances Talaska. A Manual of Laboratory and Diagnostic Tests, 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Pagana, Kathleen Deska, and Timothy James Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis, MO: Mosby, 1998.

Schull, Patricia, ed. Illustrated Guide to Diagnostic Tests, 2nded. Springhouse, PA: Springhouse Corporation, 1998.

PERIODICALS

Tahara R. W., et al. "Is There a Role for Routine Mediastinoscopy in Patients With Peripheral T1 Lung Cancers?"American Journal of Surgery (December 2000): 488-491.

Deslauriers, Jean, and Jocelyn Gregoire. "Clinical and Surgical Staging of Non-Small Cell Lung Cancer." Chest, (April 2000 supplement): 96S-103S.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA30329. 800-ACS-2345 <http://www.cancer.org>.

American Lung Association. 1740 Broadway, New York, NY10019-4374. 800-LUNG-USA (800-586-4872).<http://www.lungusa.org>.

Alliance for Lung Cancer Advocacy, Support, and Education. P.O. Box 849, Vancouver, WA 98666. 800-298-2436.<http://www.alcase.org>.

Teresa G. Norris

QUESTIONS TO ASK THE DOCTOR

  • Why do I need this test?
  • Is the test dangerous?
  • How do I prepare for the test?
  • How long will the test take?
  • Will I get general or local anesthesia?
  • How soon will I get my test results?

KEY TERMS

Endotracheal

Placed within the trachea, also known as the windpipe.

Hodgkin's disease

A malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow.

Lymph nodes

Small round structures located throughout the body; contain cells that fight infections.

Pleural space

Space between the layers of the pleura (membrane lining the lungs and thorax).

Sarcoidosis

A chronic disease characterized by nodules in the lungs, skin, lymph nodes and bones; however, any tissue or organ in the body may be affected.

Thymus

An unpaired organ in the mediastinal cavity that is important in the body's immune response.

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"Mediastinoscopy." Gale Encyclopedia of Cancer. . Encyclopedia.com. 20 Sep. 2018 <http://www.encyclopedia.com>.

"Mediastinoscopy." Gale Encyclopedia of Cancer. . Encyclopedia.com. (September 20, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy-0

"Mediastinoscopy." Gale Encyclopedia of Cancer. . Retrieved September 20, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy-0

Learn more about citation styles

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Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

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The Chicago Manual of Style

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Notes:
  • Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.
  • In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.

Mediastinoscopy

Mediastinoscopy

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the breastbone that lies between the lungs. The organs in the mediastinum include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer. It is also ordered to detect infection, and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal (within the trachea) tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.

Purpose

Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma, including Hodgkin's disease. The diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. Lung cancer staging involves the placement of the cancer's progression into stages, or levels. These stages help a physician study cancer and provide consistent definition levels of cancer and corresponding treatments. The lymph nodes in the mediastinum are likely to show if lung cancer has spread beyond the lungs. Mediastinoscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes indicates diagnosis and stages of lung cancer.

Mediastinoscopy may also be ordered to verify a diagnosis that was not clearly confirmed by other methods, such as certain radiographic and laboratory studies. Mediastinoscopy may also aid in certain surgical biopsies of nodes or cancerous tissue in the mediastinum. In fact, the surgeon may immediately perform a surgical procedure if a malignant tumor is confirmed while the patient is undergoing mediastinoscopy, thus combining the diagnostic exam and surgical procedure into one operation when possible.

Although still performed in 2001, advancements in computed tomography (CT) and magnetic resonance imaging (MRI) techniques, as well as the new developments in ultrasonography, have led to a decline in the use of mediastinoscopy. In addition, better results of fine-needle aspiration (drawing out fluid by suction) and core-needle biopsy (using a needle to obtain a small tissue sample) investigations, along with new techniques in thoracoscopy (examination of the thoracic cavity with a lighted instrument called a thoracoscope) offer additional options in examining mediastinal masses. Mediastinoscopy may be required, however, when these other methods cannot be used or when the results they provide are inconclusive.

Precautions

Because mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Patients who previously had mediastinoscopy should not receive it again if there is scarring present from the first exam.

Several other medical conditions, such as impaired cerebral circulation, obstruction or distortion of the upper airway, or thoracic aortic aneurysm (abnormal dilation of the thoracic aorta) may also preclude mediastinoscopy. Anatomic structures that can be compressed by the mediastinoscope may complicate these pre-existing medical conditions.

Description

Mediastinoscopy is usually performed in a hospital under general anesthesia. An endotracheal tube is inserted first, after local anesthesia is applied to the throat. Once the patient is under general anesthesia, a small incision is made usually just below the neck or at the notch at the top of the breastbone. The surgeon may clear a path and feel the patient's lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician will insert the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light that allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform biopsies. A sample of tissue from the lymph nodes or a mass can be extracted and sent for study under a microscope or on to a laboratory for further testing.

In some cases, analysis of the tissue sample which shows malignancy will suggest the need for immediate surgery while the patient is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue extraction and stitch the small incision closed. The patient will remain in the surgery recovery area until it is determined that the effects of anesthesia have lessened and it is safe for the patient to leave the area. The entire procedure should take about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a safe, thorough, and cost-effective diagnostic tool with less risk than some other procedures.

Preparation

Patients are asked to sign a consent form after having reviewed the risks of mediastinoscopy and known risks or reactions to anesthesia. The physician will normally instruct the patient to fast from midnight before the test until after the procedure is completed. A physician may also prescribe a sedative the night before the exam and before the procedure. Often a local anesthetic will be applied to the throat to prevent discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored to watch for changes in vital signs or indications of complications of the procedure or the anesthesia. A patient may have a sore throat from the endotracheal tube, temporary chest pain, and soreness or tenderness at the site of incision.

Risks

Complications from the actual mediastinoscopy procedure are relatively rarethe overall complication rate in various studies has been 1.3-3.0%. However, the following complications, in decreasing order of frequency, have been reported:

  • hemorrhage
  • pneumothorax (air in the pleural space)
  • recurrent laryngeal nerve injury, causing hoarseness
  • infection
  • tumor implantation in the wound
  • phrenic nerve injury (injury to a thoracic nerve)
  • esophageal injury
  • chylothorax (chylea milky lymphatic fluidin the pleural space)
  • air embolism (air bubble)
  • transient hemiparesis (paralysis on one side of the body)

The usual risks associated with general anesthesia also apply to this procedure.

Normal results

In the majority of procedures performed to diagnose cancer, a normal result involves evidence of small, smooth, normal-appearing lymph nodes and no abnormal tissue, growths, or signs of infection. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

Abnormal results

Abnormal findings may indicate lung cancer, tuberculosis, the spread of disease from one body part to another, sarcoidosis (a disease that causes nodules, usually affecting the lungs), lymphoma (abnormalities in the lymph tissues), and Hodgkin's disease.

Resources

BOOKS

Fischbach, Frances Talaska. A Manual of Laboratory and Diagnostic Tests. 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Pagana, Kathleen Deska, and Timothy James Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis, MO: Mosby, 1998.

PERIODICALS

Deslauriers, Jean, and Jocelyn Gregoire. "Clinical and Surgical Staging of Non-Small Cell Lung Cancer." Chest, Supplement (April 2000): 96S-103S.

Tahara R. W., et al. "Is There a Role for Routine Mediastinoscopy in Patients With Peripheral T1 Lung Cancers?" American Journal of Surgery December 2000: 488-491.

ORGANIZATIONS

Alliance for Lung Cancer Advocacy, Support, and Education. P.O. Box 849, Vancouver, WA 98666. (800) 298-2436. http://www.alcase.org.

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. 800-ACS-2345 http://www.cancer.org.

American Lung Association. 1740 Broadway, New York, NY 10019-4374. 800-LUNG-USA (800-586-4872). http://www.lungusa.org.

KEY TERMS

Endotracheal Placed within the trachea, also known as the windpipe.

Hodgkin's disease A malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow.

Lymph nodes Small round structures located throughout the body; contain cells that fight infections.

Pleural space Space between the layers of the pleura (membrane lining the lungs and thorax).

Sarcoidosis A chronic disease characterized by nodules in the lungs, skin, lymph nodes and bones; however, any tissue or organ in the body may be affected.

Thymus An unpaired organ in the mediastinal cavity that is important in the body's immune response.

Cite this article
Pick a style below, and copy the text for your bibliography.

  • MLA
  • Chicago
  • APA

"Mediastinoscopy." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 20 Sep. 2018 <http://www.encyclopedia.com>.

"Mediastinoscopy." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. (September 20, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy-1

"Mediastinoscopy." Gale Encyclopedia of Medicine, 3rd ed.. . Retrieved September 20, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy-1

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mediastinoscopy

mediastinoscopy (mee-di-asti-nos-kŏpi) n. examination of the mediastinum, usually by means of an endoscope inserted through a small incision in the neck region. It can be used to assess the spread of intrathoracic tumours and for lymph node biopsy.

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Mediastinoscopy

Mediastinoscopy

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the breastbone that lies between the lungs. The organs in the mediastinum include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer. It is also ordered to detect infection, and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.

Purpose

This procedure allows direct visualization of the tissues and organs in the chest cavity behind the sternum (breastbone) and is used to detect or evaluate infections and various types of cancers. Originally the aim of mediastinoscopy was to retrieve tissue samples for microscopic analysis. Other indications for the procedure are diagnosing pulmonary lesions and predicting the benefit of surgery. Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma, including Hodgkin's disease. Diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. The lymph nodes in the mediastinum are likely to show if lung cancer has spread beyond the lungs (metastatis). Mediastinoscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes can indicate the diagnosis and staging of lung cancer.

Alternatives to mediastinoscopy, such as computed tomography (CT), magnetic resonance imaging (MRI), and new developments in ultrasonography, have resulted in a decrease in the number of mediastinoscopies performed. In addition, fine-needle aspiration and core-needle biopsy procedures coupled with new techniques in thoracoscopy have brought alternative possibilities in examining mediastinal masses. As of 2000, the choice of procedures is one of the most controversial issues in the staging of lung cancer.

Precautions

Since mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Patients who previously had mediastinoscopy should not receive it again if there is scarring present from the first exam.

Mediastinoscopy is contraindicated in those patients who have a superior vena cava obstruction, due to the risk of hemorrhage. The procedure is also contraindicated for patients with a tracheotomy.

Description

Mediastinoscopy is usually performed in a hospital under general anesthesia. An endotracheal tube is inserted first, after local anesthesia is applied to the throat. Once the patient is under general anesthesia, a small incision is made usually just below the neck. The surgeon may clear a path and feel the patient's lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician will insert the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light, which allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform the exam. A sample of tissue from the lymph nodes or one of the organs can be extracted and sent for study under a microscope or on to a laboratory for further testing.

In some cases, analysis of the tissue sample that shows malignancy will suggest the need for immediate surgery while the patient is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue extraction and stitch the small incision closed. The patient will remain in the surgery recovery area until it is determined that the effects of anesthesia have lessened and it is safe for the patient to leave the area. The entire procedure should take about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a thorough and cost-effective diagnostic tool with less risk than some other procedures. Mediastinoscopy has been shown to be an effective and safe technique for biopsy of mediastinal masses in the pediatric population.

Preparation

Patients should sign a consent form after having reviewed the risks of mediastinoscopy and known risks or reactions to anesthesia. The patient should have nothing to eat or drink after midnight the day of the procedure, or at least 8 hours before the exam. A local anesthetic may be applied to the throat to ease discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored for changes in vital signs or indications of complications of the procedure or the anesthesia. A patient may have a sore throat from the endotracheal tube and temporary chest pain, soreness, or tenderness at the site of incision.

Complications

Complications from the actual mediastinoscopy procedure are relatively rare. Risks to internal organs consist of puncture of the esophagus, trachea, or the blood vessels in the area. Air leaks from the lung can also occur and occasionally require additional treatment. Infection and hemorrhage are other rare complications. The usual risks associated with general anesthesia apply to this procedure. General anesthesia is safe for most patients, but it is estimated to cause major or minor complications in 3-10% of those having surgery of all types.

Results

In the majority of procedures performed to diagnose cancer, a normal result would involve evidence of normal lymph nodes and no tumors. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

If the lymph nodes are malignant, this indicates that a cancer such as lymphoma (including Hodgkin's disease), lung cancer, or esophageal cancer are present.

Health care team roles

Either a surgeon or a trained pulmonary specialist performs this procedure. An anesthesiologist will obtain a medical history and supervise the anesthesia for the procedure. A Certified Registered Nurse Anesthetist (CRNA) may work under the direction of the anesthesiologist. Operating room personnel include the scrub person and a circulator. Depending on the facility, there may be unlicensed assistive personnel (UAPs) in attendance, as well.

Patient education

After the procedure, the patient will experience some pain and soreness at the incision site, and possibly a sore throat from the endotracheal tube. Pain at the incision site may last for up to two weeks after the procedure. Patients should be instructed that there will be a small scar wherever the instruments were inserted. There will be a small dressing over the incision. The incision site must be kept clean and dry for 48 hours, and then patients may shower.

Patients should notify their health care provider if they develop any of these symptoms:

  • redness at the incision site
  • drainage of blood or pus from the incision site
  • fever more than 101°F (38.3°C)
  • progressive swelling at the incision site

KEY TERMS

Endotracheal— Within the trachea, which is commonly known as the windpipe.

Hodgkin's disease— A malignant disorder of lymph tissue (lymphoma) that appears to originate in a particular lymph node and later spreads to the spleen, liver, and bone marrow.

Mediastinum— The mass of organs and tissues separating the lungs. It contains the heart and large vessels, trachea, esophagus, thymus, lymph nodes, and connective tissue.

Sarcoidosis— A chronic disease known for development of nodules in the lungs, skin, lymph nodes, and bones.

Superior vena cava— The principal vein that drains the upper portion of the body.

Tracheotomy— Incision of the trachea through the skin and muscles of the neck.

Resources

BOOKS

Fraser, R.S., and P.D. Pare. "Endoscopy and Diagnostic Biopsy Procedures." In Diagnosis of Diseases of the Chest, 4th ed., Vol. I. Philadelphia: W.B. Saunders Company, 1999.

George, Ronald, Richard Light, Michael Matthay, and Richard Matthay. "Lung Neoplasms." In Chest Medicine: Essentials of Pulmonary and Critical Care Medicine, 4th ed. Philadelphia: Lippincott, 2000.

Pagana, Kathleen D., and Timothy J. Pagana. Diagnostic Testing and Nursing Implications, 5th ed. St. Louis: Mosby, 1999.

PERIODICALS

Glick, R.D., and I.A. Pearse. "Diagnosis of Mediastinal Masses in Pediatric Patients Using Mediastinoscopy and the Chamberlain Procedure." Journal of Pediatric Surgery 34, no. 4 (April 1999): 559-64.

Hammoud, Z.T., and R.C. Anderson. "The Current Role of Mediastinoscopy in the Evaluation of Thoracic Disease." Journal of Thoracic and Cardiovascular Surgery 118, no.5 (November 1999): 894-9.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) ACS-2345. 〈http://www.cancer.org〉.

American College of Chest Physicians. 3300 Dundee Rd, Northbrook, IL 60062-2348. (800) 343-2227. 〈http://www.chestnet.org〉.

American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) LUNG-USA. 〈http://www.lungusa.org〉.

OTHER

Harvard Medical School Family Health Guide. 8 August 2001. 〈http://www.health.harvard.edu/fhg/diagnostics/mediastinoscopy/mediastinoscopy.shtml〉.

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Mediastinoscopy

Mediastinoscopy

Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the sternum (breastbone) that lies between the lungs. The organs in the mediastinum

include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer. It is also ordered to detect infection, and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal (within the trachea) tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.

Purpose

Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma, including Hodgkin’s disease. The diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. Lung cancer staging involves a determination of the level or progression of the cancer into stages. These stages help a physician study cancer and provide consistent cancer definition levels and corresponding treatments. They also provide some guidance as to prognosis. The lymph nodes in the mediastinum are likely to reveal if lung cancer has spread beyond the lungs. Mediasti-noscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes indicates the diagnosis and stage of lung cancer.

Mediastinoscopy may also be ordered to verify a diagnosis that was not clearly confirmed by other methods, such as certain radiographic and laboratory studies. Mediastinoscopy may aid in some surgical biopsies of nodes or cancerous tissue in the mediastinum. In fact, a surgeon may immediately perform a surgical procedure if a malignant tumor is confirmed while the patient is undergoing mediastinoscopy. In these cases, the diagnostic exam and surgical procedure are combined into one operation.

Mediastinoscopy provides a diagnosis in 10-75% of cases, depending on histology, location, and size of cancer. The false positive rate, however can be as high as 20%.

Demographics

Approximately 130,000 new pulmonary nodules are diagnosed each year in the United States. Of those, half are malignant. The majority of pulmonary nodules are diagnosed via mediastinoscopy.

KEY TERMS

Endotracheal— Placed within the trachea, also known as the windpipe.

Hodgkin’s disease— A malignancy of lymphoid tissue found in the lymph nodes, spleen, liver, and bone marrow.

Lymph nodes— Small round structures located throughout the body; contain cells that fight infections.

Pleural space— Space between the layers of the pleura (membrane lining the lungs and thorax).

Sarcoidosis— A chronic disease characterized by nodules in the lungs, skin, lymph nodes, and bones; however, any tissue or organ in the body may be affected.

Thymus— An unpaired organ in the mediastinal cavity that is important in the body’s immune response.

Description

Mediastinoscopy is usually performed in a hospital under general anesthesia. Before the general anesthesia is administered, local anesthesia is applied to the throat while an endotracheal tube is inserted. Once the patient is under general anesthesia, a small incision is made, usually just below the neck or at the notch at the top of the sternum. The surgeon may clear a path and feel the person’s lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician inserts the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light that allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform biopsies. A tissue sample from the lymph nodes or a mass can be removed and sent for study under a microscope, or to a laboratory for further testing.

In some cases, tissue sample analysis that shows malignancy will suggest the need for immediate surgery while the person is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue removal, and stitch the small incision closed. The person will remain in the surgerical recovery area until the effects of anesthesia have lessened and it is safe to leave the area. The entire procedure should require about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a safe, thorough, and cost-effective diagnostic tool with less risk than some other procedures.

Diagnosis/Preparation

Because mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam’s findings outweigh the risks of surgery and anesthesia. Individuals who previously had mediastinoscopy should not receive it again if there is scarring from the first exam.

Several other medical conditions, such as impaired cerebral circulation, obstruction or distortion of the upper airway, or thoracic aortic aneurysm (abnormal dilation of the thoracic aorta) may also preclude mediastinoscopy. Certain structures in a person’s anatomy that can be compressed by the mediastinoscope may complicate these pre-existing medical conditions.

Patients are asked to sign a consent form after reviewing the risks of mediastinoscopy and known risks and reactions to anesthesia. The physician will normally instruct the patient to fast from midnight before the test until after the procedure is completed. A physician may also prescribe a sedative the night before the exam and again before the procedure. Often a local anesthetic will be applied to the throat to prevent discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored and watched for changes in vital signs, or symptoms of complications from the procedure or anesthesia. The patient may have a sore throat from the endotracheal tube, experience temporary chest pain, and have soreness or tenderness at the incision site.

Risks

Complications from the actual mediastinoscopy procedure are relatively rare. The overall complication rates in various studies have been reported in the range of 1.3-3%. However, the following complications, in decreasing order of frequency, have been reported:

  • hemorrhage
  • pneumothorax (air in the pleural space)
  • recurrent laryngeal nerve injury, causing hoarseness
  • infection
  • tumor implantation in the wound
  • phrenic nerve injury (injury to a thoracic nerve)
  • esophageal injury
  • chylothorax (chyle is milky lymphatic fluid in the pleural space)
  • air embolism (air bubble)
  • transient hemiparesis (paralysis on one side of the body)

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

A mediastinoscopy procedure is usually performed by a thoracic or general surgeon in a hospital setting.

The usual risks associated with general anesthesia also apply to this procedure.

Normal results

In the majority of procedures performed to diagnose cancer, a normal result indicates the presence of small, smooth lymph nodes with no abnormal tissue, growths, or signs of infection. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

Abnormal findings may indicate lung cancer, tuberculosis, the spread of disease from one body part to another, sarcoidosis (a disease that causes nodules, usually affecting the lungs), lymphoma (abnormalities in the lymph tissues), and Hodgkin’s disease.

Morbidity and mortality rates

Complications of mediastinoscopy include bleeding, pain, and post-procedure infection. These are relatively uncommon. Mortality is extremely rare.

Alternatives

A less invasive technique is ultrasound. However, it is not as specific as mediastinoscopy, and the information obtained is not as useful in making a diagnosis.

Although still performed, there is a decline in the use of mediastinoscopy as a result of advancements in computed tomography (CT), magnetic resonance imaging (MRI), and ultrosonography techniques. In addition, improved fine-needle aspiration (withdrawing fluid using suction) results of and core-needle biopsy (using a needle to obtain a small tissue sample) investigations, along with new techniques in thoracoscopy (examination of the thoracic cavity with a lighted instrument called a thoracoscope) offer additional options in examining masses in the mediastinum. Mediastinoscopy may be required when other methods cannot be used or when they provide inconclusive results.

QUESTIONS TO ASK THE DOCTOR

  • Why is this test needed?
  • Is the test dangerous?
  • What test preparation is required?
  • How long will the test take?
  • When will the results be available?
  • What form of anesthesia will be used?
  • Is the surgeon board certified?
  • How many mediastinoscopy procedures has the surgeon performed?
  • What is the surgeon’s complication rate?

Resources

BOOKS

Bland, K.I., W.G. Cioffi, M.G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.

Fischbach, F. and F. Talaska. A Manual of Laboratory and Diagnostic Tests, 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Grace, P.A., A. Cuschieri, D. Rowley, N. Borley, A. Darzi. Clinical Surgery, 2nd ed. London: Blackwell Publishing, 2003.

Schwartz, S.I., J.E. Fischer, F.C. Spencer, G.T. Shires, J.M. Daly, J.M. Principles of Surgery, 7th ed. New York: McGraw Hill, 1998.

Townsend, C., K.L. Mattox, R.D. Beauchamp, B.M. Evers, D.C. Sabiston. Sabiston’s Review of Surgery, 3rd ed. Philadelphia: Saunders, 2001.

PERIODICALS

Beadsmoore C.J., N.J. Screaton. “Classification, Ttaging and Prognosis of Lung Cancer.” European Journal of Radiology 45, no 1 (2003): 8–17.

Choi, Y.S., Y.M. Shim, J. Kim, K. Kim. “Mediastinoscopy in Patients with Clinical Stage I Non-small Cell Lung Cancer.” Annals of Thoracic Surgery 75, no. 2 (2003): 364–6.

Detterbeck, F.C., M.M. DeCamp, Jr., L.J. Kohman, G.A. Silvestri. “Lung cancer. Invasive staging: the guidelines.” Chest 123, no. 1 Supply (2003): 167S-175S.

Falcone F., F. Fois, D. Grosso. “Endobronchial Ultrasound.” Respiration 70, no. 2 (2003): 179–94.

Sterman, D.H., E. Sztejman, E. Rodriguez, J. Friedberg. “Diagnosis and Staging of ‘Other Bronchial Tumors’.” Chest Surgery Clinics of North America 13, no. 1 (2003): 79–94.

ORGANIZATIONS

American Board of Surgery. 1617 John F. Kennedy Boulevard, Suite 860, Philadelphia, PA 19103. (215) 568-4000. Fax: (215) 563-5718. http://www.absurgery.org.

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org.

American College of Surgeons. 633 North St. Clair Street, Chicago, IL 60611-32311. (312) 202-5000. Fax: (312) 202-5001. [email protected] http://www.facs.org.

American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) 586-4872. http://www.lungusa.org.

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.ama-assn.org.

Society of Thoracic Surgeons. 633 N. Saint Clair St., Suite 2320, Chicago, IL 60611-3658. (312) 202-5800. Fax: (312) 202-5801. <[email protected]>. http://www.sts.org.

OTHER

Creighton University School of Medicine. [cited May 14, 2003]. <http://medicine.creighton.edu/forpatients/mediast/mediastin.html>.

Harvard University Medical School. [cited May 14, 2003]. http://www.health.harvard.edu/fhg/diagnostics/mediastinoscopy/mediastinoscopy.shtml.

Merck Manual. [cited May 14, 2003]. http://www.merck.com/pubs/mmanual/section6/chapter65/65i.htm.

University of Missouri. [cited May 14, 2003]. http://www.ellisfischel.org/thoracic/testing/mediastinoscopy.shtml.

L. Fleming Fallon, Jr., M.D., Dr.PH.

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"Mediastinoscopy." The Gale Encyclopedia of Surgery and Medical Tests. . Retrieved September 20, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/mediastinoscopy-3

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Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

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Mediastinoscopy

Mediastinoscopy

Definition

Mediastinoscopy is a surgical procedure that allows physicians to view areas of the mediastinum, the cavity behind the breastbone that lies between the lungs . The organs in the mediastinum include the heart and its vessels, the lymph nodes, trachea, esophagus, and thymus.

Mediastinoscopy is most commonly used to detect or stage cancer . It is also ordered to detect infection , and to confirm diagnosis of certain conditions and diseases of the respiratory organs. The procedure involves insertion of an endotracheal tube, followed by a small incision in the chest. A mediastinoscope is inserted through the incision. The purpose of this equipment is to allow the physician to directly see the organs inside the mediastinum, and to collect tissue samples for laboratory study.

Purpose

This procedure allows direct visualization of the tissues and organs in the chest cavity behind the sternum (breastbone) and is used to detect or evaluate infections and various types of cancers. Originally the aim of mediastinoscopy was to retrieve tissue samples for microscopic analysis. Other indications for the procedure are diagnosing pulmonary lesions and predicting the benefit of surgery. Mediastinoscopy is often the diagnostic method of choice for detecting lymphoma, including Hodgkin's disease. Diagnosis of sarcoidosis (a chronic lung disease) and the staging of lung cancer can also be accomplished through mediastinoscopy. The lymph nodes in the mediastinum are likely to show if lung cancer has spread beyond the lungs (metastatis). Mediastinoscopy allows a physician to observe and extract a sample from the nodes for further study. Involvement of these lymph nodes can indicate the diagnosis and staging of lung cancer.

Alternatives to mediastinoscopy, such as computed tomography (CT), magnetic resonance imaging (MRI), and new developments in ultrasonography, have resulted in a decrease in the number of mediastinoscopies performed. In addition, fine-needle aspiration and core-needle biopsy procedures coupled with new techniques in thoracoscopy have brought alternative possibilities in examining mediastinal masses. As of 2000, the choice of procedures is one of the most controversial issues in the staging of lung cancer.

Precautions

Since mediastinoscopy is a surgical procedure, it should only be performed when the benefits of the exam's findings outweigh the risks of surgery and anesthesia. Patients who previously had mediastinoscopy should not receive it again if there is scarring present from the first exam.

Mediastinoscopy is contraindicated in those patients who have a superior vena cava obstruction, due to the risk of hemorrhage. The procedure is also contraindicated for patients with a tracheotomy .

Description

Mediastinoscopy is usually performed in a hospital under general anesthesia . An endotracheal tube is inserted first, after local anesthesia is applied to the throat. Once the patient is under general anesthesia, a small incision is made usually just below the neck. The surgeon may clear a path and feel the patient's lymph nodes first to evaluate any abnormalities within the nodes. Next, the physician will insert the mediastinoscope through the incision. The scope is a narrow, hollow tube with an attached light, which allows the surgeon to see inside the area. The surgeon can insert tools through the hollow tube to help perform the exam. A sample of tissue from the lymph nodes or one of the organs can be extracted and sent for study under a microscope or on to a laboratory for further testing.

In some cases, analysis of the tissue sample that shows malignancy will suggest the need for immediate surgery while the patient is already prepared and under anesthesia. In other cases, the surgeon will complete the visual study and tissue extraction and stitch the small incision closed. The patient will remain in the surgery recovery area until it is determined that the effects of anesthesia have lessened and it is safe for the patient to leave the area. The entire procedure should take about an hour, not counting preparation and recovery time. Studies have shown that mediastinoscopy is a thorough and cost-effective diagnostic tool with less risk than some other procedures. Mediastinoscopy has been shown to be an effective and safe technique for biopsy of mediastinal masses in the pediatric population.

Preparation

Patients should sign a consent form after having reviewed the risks of mediastinoscopy and known risks or reactions to anesthesia. The patient should have nothing to eat or drink after midnight the day of the procedure, or at least 8 hours before the exam. A local anesthetic may be applied to the throat to ease discomfort during placement of the endotracheal tube.

Aftercare

Following mediastinoscopy, patients will be carefully monitored for changes in vital signs or indications of complications of the procedure or the anesthesia. A patient may have a sore throat from the endotracheal tube and temporary chest pain , soreness, or tenderness at the site of incision.

Complications

Complications from the actual mediastinoscopy procedure are relatively rare. Risks to internal organs consist of puncture of the esophagus, trachea, or the blood vessels in the area. Air leaks from the lung can also occur and occasionally require additional treatment. Infection and hemorrhage are other rare complications. The usual risks associated with general anesthesia apply to this procedure. General anesthesia is safe for most patients, but it is estimated to cause major or minor complications in 3–10% of those having surgery of all types.

Results

In the majority of procedures performed to diagnose cancer, a normal result would involve evidence of normal lymph nodes and no tumors. In the case of lung cancer staging, results are related to the severity and progression of the cancer.

If the lymph nodes are malignant, this indicates that a cancer such as lymphoma (including Hodgkin's disease), lung cancer, or esophageal cancer are present.

Health care team roles

Either a surgeon or a trained pulmonary specialist performs this procedure. An anesthesiologist will obtain a medical history and supervise the anesthesia for the procedure. A Certified Registered Nurse Anesthetist (CRNA) may work under the direction of the anesthesiologist. Operating room personnel include the scrub person and a circulator. Depending on the facility, there may be unlicensed assistive personnel (UAPs) in attendance, as well.

Patient education

After the procedure, the patient will experience some pain and soreness at the incision site, and possibly a sore throat from the endotracheal tube. Pain at the incision site may last for up to two weeks after the procedure. Patients should be instructed that there will be a small scar wherever the instruments were inserted. There will be a small dressing over the incision. The incision site must be kept clean and dry for 48 hours, and then patients may shower.

Patients should notify their health care provider if they develop any of these symptoms:

  • redness at the incision site
  • drainage of blood or pus from the incision site
  • fever more than 101°F (38.3 °C)
  • progressive swelling at the incision site

KEY TERMS


Endotracheal —Within the trachea, which is commonly known as the windpipe.

Hodgkin's disease —A malignant disorder of lymph tissue (lymphoma) that appears to originate in a particular lymph node and later spreads to the spleen, liver, and bone marrow.

Mediastinum —The mass of organs and tissues separating the lungs. It contains the heart and large vessels, trachea, esophagus, thymus, lymph nodes, and connective tissue.

Sarcoidosis —A chronic disease known for development of nodules in the lungs, skin, lymph nodes, and bones.

Superior vena cava —The principal vein that drains the upper portion of the body.

Tracheotomy —Incision of the trachea through the skin and muscles of the neck.


Resources

BOOKS

Fraser, R. S., and P. D. Pare. "Endoscopy and Diagnostic Biopsy Procedures." In Diagnosis of Diseases of the Chest. 4th ed., vol. I. Philadelphia: W.B. Saunders Company, 1999.

George, Ronald, Richard Light, Michael Matthay, and Richard Matthay. "Lung Neoplasms." In Chest Medicine: Essentials of Pulmonary and Critical Care Medicine. 4th ed. Philadelphia: Lippincott, 2000.

Pagana, Kathleen D., and Timothy J. Pagana. Diagnostic Testing and Nursing Implications. 5th ed. St. Louis: Mosby, 1999.

PERIODICALS

Glick, R. D., and I. A. Pearse. "Diagnosis of Mediastinal Masses in Pediatric Patients Using Mediastinoscopy and the Chamberlain Procedure." Journal of Pediatric Surgery 34, no. 4 (April 1999): 559–64.

Hammoud, Z. T., and R. C. Anderson. "The Current Role of Mediastinoscopy in the Evaluation of Thoracic Disease."Journal of Thoracic and Cardiovascular Surgery 118, no. 5 (November 1999): 894–9.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) ACS-2345. <http://www.cancer.org>.

American College of Chest Physicians. 3300 Dundee Rd, Northbrook, IL 60062-2348. (800) 343-2227. <http://www.chestnet.org>.

American Lung Association. 1740 Broadway, New York, NY 10019-4374. (800) LUNG-USA. <http://www.lungusa.org>.

OTHER

Harvard Medical School Family Health Guide. 8 August 2001. <http://www.health.harvard.edu/fhg/diagnostics/mediastinoscopy/mediastinoscopy.shtml>.

Maggie Boleyn, RN, BSN

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