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Mediastinoscopy is a procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy.^[1] Mediastinoscopy is often used for staging of lymph nodes of lung cancer or for diagnosing other conditions affecting structures in the mediastinum such as sarcoidosis or lymphoma.

Mediastinoscopy involves making an incision approximately 1 cm above the suprasternal notch of the sternum, or breast bone. Dissection is carried out down to the pretracheal space and down to the carina. A scope (mediastinoscope) is then advanced into the created tunnel which provides a view of the mediastinum. The scope may provide direct visualization or may be attached to a video monitor.

Mediastinoscopy provides access to mediastinal lymph node levels 2, 4, and 7.

Extended mediastinoscopy

Extended mediastinoscopy is a technique which allows access to the pre-aortic (station 6) and aortopulmonary window (station 5) lymph nodes.

Parasternal mediastinotomy

Parasternal mediastinotomy, aka, a Chamberlain procedure, is the standard approach to access lymph nodes at stations 5 and 6.

References

^ Kaiser LR (2008). Fishman's Pulmonary Diseases and Disorders (4th ed.). McGraw-Hill. p. 1853–1854. ISBN 0-07-145739-9.

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1. 縦隔リンパ節腫脹の外科的マネージメント surgical management of mediastinal lymphadenopathy
2. 縦隔腫瘤の評価 evaluation of mediastinal masses
3. 非小細胞肺癌の診断および病期分類 diagnosis and staging of non small cell lung cancer
4. 縦隔における内視鏡的超音波ガイド下穿刺吸引 endoscopic ultrasound guided fine needle aspiration in the mediastinum
5. 胸腔鏡の概要 an overview of medical thoracoscopy

English Journal

Comparison of Clinical and Surgical-Pathological Staging in IIIA Non-Small Cell Lung Cancer Patients.

Muehling B, Wehrmann C, Oberhuber A, Schelzig H, Barth T, Orend KH.SourceDepartment of Thoracic and Vascular Surgery, University of Ulm, Ulm, Germany, bernd.muehling@uniklinik-ulm.de.
Annals of surgical oncology.Ann Surg Oncol.2012 Jan;19(1):89-93. Epub 2011 Jul 14.
BACKGROUND: The heterogeneous group of IIIA NSCLC patients requires careful preoperative clinical staging as tumor size and lymph node involvement guide treatment. The purpose of our study was to analyze the correctness of clinical staging in IIIA patients.METHODS: Retrospective analysis of all pati
PMID 21755379

[The basis of Churg-Strauss syndrome diagnosis in own material.]

Fijołek J, Wiatr E, Gawryluk D, Langfort R, Kober J, Piotrowska-Kownacka D, Oniszh K.AbstractIntroduction: The diagnosis of Churg-Strauss syndrome (CSS) is difficult because pathological criteria are present in minority of patients and in advanced stages. Several centers elaborated criteria which allowed to suspect CSS in patients with asthma, hypereosinophilia and clinical manifestations consistent with systemic vasculitis with or without histologic evidence. The aim of the study is the presentation of the basis of CSS diagnosis in our material. Material and methods: The analysis included 38 patients. Blood and biochemical analysis, radiological examinations of the chest and sinuses, echocardiography were performed in all patients. In 22/23 patients with cardiac symptoms magnetic resonance of the heart was performed. In two patients mediastinoscopy was performed, in 4 - laparotomy. Results: Only in 13/38 patients vasculitis was histologically proven, in the rest the diagnosis was established mainly on clinical ground. In 23 patients the diagnosis was established on the clinical cardiac symptoms - in all of them the cardiac involvement was confirmed by magnetic resonance. In 9 cases skin leasions were cause of further diagnostic procedures, 6 patients presented gastrointestinal symptoms, in 15 - paralysis of peroneal nerve was observed, and 1 patient had polyneuropathy and symptoms of central nervous system. Conclusions: The diagnosis of CSS in our material was established mainly on clinical ground, because histologic material was difficult to obtain (it needs invasive procedures). Only in 13 from 38 patients vasculitis was histologically proven. The presence of asthma, sinusitis associated with peripheral eosinophilia and organ symptoms suggesting a vasculitis could support the diagnosis, without histologic evidence. Pneumonol. Alergol. Pol. 2012; 80, 1: 20-28.
Pneumonologia i alergologia polska : organ Polskiego Towarzystwa Ftyzjopneumonologicznego, Polskiego Towarzystwa Alergologicznego, i Instytutu Gruzlicy i Chorob Pluc.Pneumonol Alergol Pol.2012;80(1):20-28.
Introduction: The diagnosis of Churg-Strauss syndrome (CSS) is difficult because pathological criteria are present in minority of patients and in advanced stages. Several centers elaborated criteria which allowed to suspect CSS in patients with asthma, hypereosinophilia and clinical manifestations
PMID 22187177

Japanese Journal

Successful management of severe pulmonary artery injury during mediastinoscopy

NAGAYASU Takeshi,TAGAWA Tsutomu,YAMASAKI Naoya,TSUCHIYA Tomoshi,MIYAZAKI Takuro
General thoracic and cardiovascular surgery 59(1), 73-75, 2011-01-10
NAID 10028174479

Efficacy of Convex Probe Endobronchial Ultrasound (CP-EBUS) Assisted Transbronchial Needle Aspiration for Mediastinal Staging in Non-small Cell Lung Cancer Cases with Mediastinal Lymphadenopathy

Cetinkaya Erdogan,Seyhan Ekrem Cengiz,Ozgul Akif,Gencoglu Atayla,Ozgul Guler,Cam Ertan,Kamiloglu Emine
Annals of Thoracic and Cardiovascular Surgery 17(3), 236-242, 2011
… 12 patients (23%) with negative lymph node samples were underwent mediastinoscopy. …
NAID 130000727990