The value of parasternal mediastinoscopy in staging bronchial carcinoma

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Abstract
Computed tomography (CT) is the non-invasive staging procedure of choicefor assessment of metastasis to mediastinal lymph nodes in patients withbronchial carcinoma. Cervical mediastinoscopy can provide histologicevidence of mediastinal spread to the peritracheal, tracheobronchial andsubcarinal lymph nodes. Sub-aortic and para-aortic nodes cannot be sampledvia this route. The present study was performed to assess the staging valueof the parasternal mediastinoscopy as a separate entity. Cervical andparasternal mediastinoscopy was performed in 37 patients with a provendiagnosis of non-small cell carcinoma of the left upper lobe. In 16patients lymph node or tumor tissue could be biopsied via the parasternalroute, in 21 patients no parasternal biopsy was taken. Of the 16 cases withbiopsies, only one was positive (6%). Histologic examination of lymph nodebiopsy tissue was false negative in one other patient (6%). Of the 21patients without biopsies taken during parasternal mediastinoscopy, three(14%) had proven lymphogenic spread to the subaortic and para-aortic nodes,detected at thoracotomy. The parasternal procedure changed treatment inonly one patient (3%). Diagnostic sensitivity was 20%. It is concluded thatparasternal mediastinoscopy should not be used as a routine stagingprocedure in patients with left upper lobe lung cancer.

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