Mediastinoscopy

Mediastinoscopy is a crucial diagnostic and staging procedure used primarily in managing lung cancer. At the time of diagnosis, approximately 75% of patients with lung cancer present with either locally advanced or metastatic disease, underscoring the importance of precise staging for effective treatment planning. Mediastinoscopy involves making a small incision at the base of the neck to insert a mediastinoscope, which allows for direct visualization and biopsy of the mediastinal lymph nodes. This invasive technique offers an 80% to 95% sensitivity rate for detecting tumor cells in these lymph nodes. However, its specificity rate of 91% to 95% reflects limitations in accessing certain lymph node stations, such as the paraesophageal, aortopulmonary, and lower pulmonary ligament nodes.

Mediastinoscopy can be categorized into 2 types: cervical mediastinoscopy and transthoracic mediastinoscopy. Cervical mediastinoscopy is a more commonly performed procedure that provides access to the pretracheal, paratracheal, and anterior subcarinal lymph nodes. Transthoracic mediastinoscopy, also known as the Chamberlain procedure or anterior mediastinotomy, is a more involved procedure that allows for the dissection of the aortopulmonary lymph nodes.

The history of mediastinal surgery dates back to 1899 when a superior mediastinal abscess was successfully drained. However, it wasn't until the late 1950s, with the introduction of the mediastinoscope by Eric Carlens of Sweden, that the procedure became widely used outside Europe. This innovation allowed for more precise biopsies of the paratracheal and hilar lymph nodes, significantly improving the accuracy of lung cancer staging and, thus, the overall management of thoracic oncologic diseases.