Does video-assisted mediastinoscopy have a better lymph node yield and safety profile than conventional mediastinoscopy?

Department of Cardiothoracic Surgery, The London Chest Hospital, London, UK.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 12/2011; 14(3):316-9. DOI: 10.1093/icvts/ivr052
Source: PubMed


A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node yield and safety profile than the conventional mediastinoscopy (CM). A total of 194 papers were found, using the reported searches, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two studies to date have directly compared CM and VAM with respect to lymph node yield, calculated diagnostics performance and complication rate. In both of these, lymph node yield is shown to be higher using VAM with better sensitivity, negative predictive value and accuracy rates. The favourable figures of lymph node sampling are found to be statistically significant in the single study providing such analysis. Complication rates using VAM are low, however, in the one instance where it is reported as higher than CM, the extensive lymph node dissection used in this technique may be a reasonable explanation for this finding. All studies described here exemplify VAM as a safe and useful tool in mediastinal staging, lymph node dissection and tissue diagnosis of mediastinal diseases given its superior visualization of surrounding structures and advantage of bimanual dissection. The future scope for diagnostic and therapeutic indications of cervical mediastinscopy is anticipated with recent advances and new techniques, such as video-assisted mediastinoscopic lymphadenectomy and virtual mediastinscopy.

11 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: When a mediastinal disease is suspected, the conventional chest X-ray remains the diagnostic procedure of first choice. However, the gold standard for evaluation of the mediastinum is represented by thoracic computed tomography, which demonstrates all important structures of this region and supplies information about pathologic changes of the lung hilus and parenchyma. Until today, with the exception of echocardiography, noninvasive sonographic examination of the mediastinum is not routinely performed. The potential of this procedure, which is supported by the good accessibility to the region and its predominantly solid structure, appears not yet adequately used. To evaluate and compare the sonographic findings, it seems essential to establish a standardized examination procedure as well as a clear definition of anatomic regions. Since lymphadenopathy represents the most frequent pathologic finding in the mediastinum, the definition of the mediastinal regions is made with respect to the lymphatic pathways. Clinically relevant mediastinal lesions are predominantly located in the aortopulmonary window or the paratracheal region, which both permit facile access for sonographic examination. A transcutaneous diagnostic or therapeutic puncture of mediastinal lesions can safely be performed under sonographic guidance.
    Medizinische Klinik 09/2002; 97(8):472-9. · 0.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Lung cancer is highly aggressive and tends to metastasize early. Therefore, accurate mediastinal staging is important for therapeutic decision making. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive procedure for mediastinal lymph node sampling and cancer staging. Classical EBUS-TBNA cytology has been combined with molecular staging techniques to improve sensitivity and specificity. This study aimed to assess mRNA integrity in samples acquired by EBUS-TBNA in the clinics. As proof-of-principle experiments, we also investigated whether stable miRNA could be detected in these samples. Integrity of mRNA isolated from tumor-positive EBUS-TBNA samples was assessed by calculating the RNA integrity number (RIN). In addition, 4 microRNAs were investigated (miRNA 21, miRNA 155, miRNA 200c, and miRNA 34a) because their relation to lung cancer has been documented recently. A group of patients with benign mediastinal lymphadenopathy served as a control. mRNA isolated from EBUS-TBNA samples was nearly completely degraded if handled under clinical conditions (RIN <5). Intact miRNA was detected in all samples, with no nonspecific amplification in negative control samples. miRNA 21 and miRNA 200c levels were significantly higher in tumor-positive than in control samples (miRNA 21: median, 325,678 [range, 34,822-583,502] vs. 801,430 (range, 17,013-5,362,145]; P < .05; miRNA 200c: median, 9,198 [range, 610-211,121] vs. 42,870 [range, 0-926,252]; P < .05). Under clinical conditions, mRNA detection is likely unsuitable for improving sensitivity of EBUS-TBNA-facilitated cancer staging. In contrast, detection of miRNA combined with EBUS-TBNA cytology may improve staging sensitivity. Cancer (Cancer Cytopathol) 2014. © 2014 American Cancer Society.
    Cancer Cytopathology 04/2014; 122(4). DOI:10.1002/cncy.21398 · 3.35 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography (EUS and EBUS) should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [EBUS combined with transbronchial needle aspiration (EBUSTBNA)] or the esophagus [EUS fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all mediastinal lymph nodes can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review, in two integrative parts, is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part I is dealing with an introduction into ultrasound techniques, mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques and part II with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.
    Journal of Thoracic Disease 11/2015; 7(9):E311-E325. DOI:10.3978/j.issn.2072-1439.2015.09.40 · 1.78 Impact Factor


11 Reads
Available from