[Mediastinoscopy in the staging of bronchial carcinoma--a critical assessment].

BACKGROUND

Mediastinoscopy has a high sensitivity for lymph node staging with a specificity of 100%. This compensates the disadvantage of being an invasive procedure compared to CT and PET scan. Although many studies examined the sensitivity, rate of complications and costs no data have been published concerning interindividual differences in relation to the surgeon performing the operation.

METHODS

From 6/98 to 12/99 in a prospective study all biopsied lymph nodes were documented. Histopathologic results of mediastinoscopy and the following operation were correlated with the 6 participating surgeons. From these data the sensitivity of mediastinoscopy for preoperative lymph node staging was analysed.

RESULTS

Analysis of 165 mediastinoscopies showed an overall sensitivity of 80.6%. 4.1 lymph nodes were biopsied per patient. Substantial differences were noted for individual biopsy patterns between surgeons, but surgeon-related sensitivity was similar. Lymph nodes 7 were reached in 15.2% to 90.9% and 2 left in 39.4% to 84.4%, whereas lymph nodes 4 were biopsied at similar rates by all surgeons.

CONCLUSION

The variable "surgeon" can be neglected if a sufficient number of lymph nodes is biopsied. Despite individual biopsy patter mediastinoscopy has a higher sensitivity than CT scan and is still the method for choice of preoperative staging. Internal quality control in thoracic surgery departments is desirable.