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
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.
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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.
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