Mediastinoscopy Clinical Utility Analysis

Mediastinoscopy has been applied to clinical diagnose for more than 40 years. In the short span of 40 years, it has evolved from the standard mediastinoscopy to video mediastinoscopy, from diagnosis mediastinoscopy to treatment mediastinoscopy. It surprized a lot of people for its outstanding development potential. There are three stages in its development process, including exploration, maturing and enhancing. Its important role is increasingly being recognized now. However, as an invasive surgery, the clinical application of mediastinoscopy is still subject to certain restrictions. Compared with CT and other imaging examination, mediastinoscopy has to spend more and also bear part of the surgical risk. This is the reason why some people have doubted about the practicality of mediastinoscopy, and it also caused the slow development of mediastinoscopy in china . However, through practical application of mediastinoscopy, people found that the role of mediastinoscopy can not be replaced by other methods. In some countries in Europe and the United States, thoracic surgery patients has taken mediastinoscopy for a routine examination. In recent years in China, the improvement in the application and development of mediastinoscopy has been made. Therefore, to prove the actually practical value and applicability of mediastinoscopy has a profound significance for us to promote mediastinoscopy technology in China. To compare the respective advantages and limitations between mediastinoscopy and CT, we randomly selected 2 groups of 27 cases with mediastinal lymph nodes disease from September 2004 to February 2007 in First Clinical Hospital thoracic surgery in Jilin University for retrospective analysis . Mediastinoscopy or CT were used in each of the two groups.Mediastinoscopy group data collected the 27 patients who receivded mediastinoscopy operation and suspected of mediastinal lymph node lesions by preoperative CT examination. CT random inspection team of 27 patients did not receive the mediastinoscopy operation, and directly undertake the thoracotomy. They also did postoperative pathologic examination. Mediastinoscopy inspection group adopted standards cervical mediastinal examination, chest CT group adopted conventional CT examination. We regarded≥1.0cm in short diameter, or≥1.5cm in long diameter as positive standard of lymph node. Two methods were calculated and analyzed the sensitivity, specificity, accuracy, positive predictive value, negative predictive value. We used pathological diagnosis as a standard. Statistical analysis used chi-square test, and drawed ROC curves. SPSS 10.0 software package was used to complete with all the statistics, P<0.05 was considered statistically significant difference. Mediastinoscopy group of 27 patients were diagnosed as pulmonary tuberculosis patients for five cases, one case of mediastinal germ cell tumors, one case of thymoma. eight cases of pulmonary and mediastinal lesions, 12 cases of patients with lung cancer. There was one case of small cell lung cancer patients, 11 cases of squamous cell carcinoma in the lung cancer patients. Mediastinoscopy inspection process had a 0% incidence of postoperative complications. One case of patients with small cell carcinoma due to pathological types did not want to continue treatment. Three cases of N2 metastasis in patients gave up surgery. A thoracotomy was performed with suspected lung cancer patients who continued to do lobectomy, lobe sleeve resection or wedge resection. We removed the suspicious mediastinal lymph node in the operation, and send them to pathology examination. Chest CT group of 27 patients postoperative diagnosed as pulmonary vascular sclerosis patients with tumors one case, hemangiopericytoma one case, inflammatory pseudotumor one case, two cases of lung abscess cases, two cases of tuberculosis, one case of carcinosarcoma. In the 19 cases of lung cancer patients, 3 cases were with small cell lung cancer, 16 patients were with non-small cell lung cancer. One case was not completely resected because it invaded surrounding tissue and tumor realm unclear, and 2 cases in pneumonectomy, 13 cases in lobectomy. We used surgical pathology results as a standard of the diagnosis effect of mediastinal lymph nodes to compare chest CT group to mediastinoscopy group: In the mediastinoscopy group we regarded squamous cell carcinoma, small cell carcinoma, mediastinal germ cell tumors, lymph node-positive tuberculosis as a specific diagnosis. Non-specific diagnosis as negative. Mediastinoscopy group of 27 patients were definitely diagnosed the types of mediastinal lymphadenopathy for 12 patients. no false-positive patients. But there was one case of lymph node metastases in patients with lung cancer proved to be missed after the operation. 14 patients in the all 27 patients in Chest CT group were suggested with mediastinal lymph node abnormalities by chest CT scan, but only 10 cases were confirmed by surgery. In the remaining 13 patients with no abnormal lymph nodes by CT scan, seven cases of mediastinal lymph nodes with a variety of specific diseases were confirmed after surgery. ROC curves showed mediastinoscopy had a significant meaning for the diagnosis of mediastinal lymph nodes disease, but chest CT could not finish this work well. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of chest CT group was 58.8%, 60%, 59.3%, 71.4%, 46.2%. And the mediastinoscopy inspection team were 92.3%, 100%, 96.3%, 100%, 93.3%. Mediastinoscopy was performed better in all indicators than chest CT (P<0.05).As a means of inspection, mediastinoscopy is safe and effective. It has a significant meaning in diagnosis mediastinal disease and mediastinal tumors in the lymphatic system. It is better than chest CT in sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Moreover, it has unique advantages in the judgment of mediastinal disease and guidance for follow-up treatment. Some patients with thoracic surgery can be avoided, thus reducing the suffering of the patients. In addition, mediastinoscopy provides a more accurate method of N2 stages than chest CT. It is of great significance to surgical treatment for lung cancer. We suggest that all potential resectable non-small cell lung cancer patients, regardless of whether CT shows mediastinal lymphadenopathy, should take mediastinoscopy as a routine.