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Mediastinoscopy with biopsy

Mediastinoscopy with biopsy is a procedure in which a lighted instrument (mediastinoscope) is inserted in the space in the chest between the lungs (mediastinum), and tissue is taken (biopsy) from any unusual growth or lymph nodes.

How the test is performed

This procedure is done in the hospital. You will be given general anesthesia so that you are asleep and do not feel any pain. A tube (endotracheal tube) is placed in your nose or mouth to help you breathe.

A small surgical cut is made in the neck. A device called a mediastinoscope is inserted through this cut and gently passed into the mid-part of the chest.

Tissue samples are taken of the lymph nodes around the airways. The scope is then removed and the surgical cut is closed with stitches.

A chest x-ray is usually taken at the end of the procedure.

The procedure usually takes 60 - 90 minutes.

How to prepare for the test

You must sign an informed consent form. You will not be able to have food or fluid for 8 hours before the test.

How the test will feel

You will be asleep during the procedure. There will be some tenderness at the site of the procedure afterward. You may have a sore throat after the procedure.

Most patients are released from the hospital the next morning.

The results of the biopsy are usually ready in 5 - 7 days.

Why the test is performed

This procedure is done to look at and then biopsy lymph nodes or any other abnormal growths in the front part of the mediastinum, near your chest wall.

  • The most common reason is to see if lung cancer (or another cancer) has spread to these lymph nodes. This is called staging.
  • This procedure is also done for certain infections (tuberculosis, sarcoidosis) and autoimmune disorders .

Normal Values

Biopsies of lymph node tissues are normal and do not show signs of cancer or infection.

What abnormal results mean

Abnormal findings may indicate:

What the risks are

There is a risk of puncturing the esophagus, trachea, or blood vessels. In some circumstances, this can lead to potentially fatal bleeding.

References

Park DR, Valliares E. Tumors and cysts of the mediastinum. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 76.

Putnam JB Jr. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 58.

Gamliel Z. Surgical staging for non-small cell lung cancer. Surg Oncol Clin N Am. 2011;20(4):691-700.

Lerut T, De Leyn P, Coosemans W, Decaluwe H, Decker G, Nafteux P, et al. Cervical videomediastinoscopy. Thorac Surg Clin. 2010;20(2):195-206.

Updated: 5/14/2012

Shabir Bhimji, MD, PhD, Specializing in Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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