In mediastinoscopy, a flexible or rigid viewing tube (mediastinoscope) is inserted through a small incision in the chest. Fiberoptic cables permit direct visualization of the lymph nodes located in the area between the lungs (mediastinum). A biopsy forceps may be passed through the scope to obtain lymph node tissue samples for laboratory examination. This analysis can help to detect lung diseases (since the lymph nodes receive drainage from the lungs) and diseases of the mediastinum.
Purpose of the Mediastinoscopy
- To help diagnose lung infections, sarcoidosis (a systemic disease that causes inflammation of the lungs), lymphatic or lung cancers, and some other uncommon diseases
- To determine the stage of cancer (the extent to which it has spread) in people with known lung cancer, and to assess the appropriateness of surgical treatment
Who Performs It
- A chest surgeon and a surgical team.
- A prior mediastinoscopy may be a contraindication for a second one.
Before the Mediastinoscopy
- Tell your doctor if you regularly take anticoagulant drugs. You will be instructed to discontinue them for some time before the test.
- Tell your doctor if you are or could be pregnant.
- Do not eat or drink anything for 8 hours before the test.
- Immediately before the procedure begins, an intravenous (IV) line is inserted into a vein in your arm, and you are placed under general anesthesia.
- You will be asked to remove any jewelry, glasses, contact lenses or dentures.
- A thin tube that is attached to a breathing machine may be passed into your windpipe to ensure that you breathe properly during the procedure.
What You Experience
- You will be lying down on a table in an operating room.
- A small incision is made between your collarbones, and the doctor inserts the scope into the mediastinum.
- After a close visual inspection of the lymph nodes, the doctor may pass a biopsy forceps through the scope to obtain tissue specimens from any suspicious areas.
- The scope is withdrawn, and the incision closed with sutures.
- The procedure takes about 1 hour.
Risks and Complications
- You may experience temporary chest pain, tenderness at the incision site, or a sore throat (due to the breathing tube).
- Rare complications include infection; bleeding; hoarseness; unintentional puncture of the esophagus, trachea, or great blood vessels; pneumothorax (leakage of air outside the lungs and into the pleural cavity, resulting in a collapsed lung); and damage to the laryngeal nerve of the vocal cords.
- Mediastinoscopy requires general anesthesia, and thus carries the associated risks.
After the Mediastinoscopy
- You will remain in the hospital for 1 or 2 days until you recover from the effects of anesthesia. During this time, your vital signs will be monitored, and you will be observed for any signs of complications.
- You may be given a pain reliever, if needed.
- You may return home and resume your regular activities.
- Immediately alert your doctor if you develop a cough, shortness of breath, bleeding from your stitches, severe chest pain, fever, swelling in the neck or difficulty swallowing.
- During the visual inspection of the mediastinum, the doctor will note any abnormalities.
- Tissue samples are inspected under a microscope for the presence of unusual cells, or may be cultured for infectious organisms.
- In some cases, biopsied tissue is examined immediately via frozen section. If this inspection reveals lung cancer that has not spread to the lymph nodes, surgery may be performed immediately to remove all or part of the affected lung. If lung cancer or any other malignancy is detected in the lymph nodes, surgery is usually contraindicated; nonsurgical treatments (such as radiation) may be begun.
- If a definitive diagnosis can be made, appropriate treatment will be initiated.
- If the doctor cannot make a diagnosis, additional tests, such as open lung biopsy, may be needed.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media