Indications for mediastinoscopy in bronchogenic carcinoma.

In an attempt to formulate indications for mediastinoscopy, the histologic tumor type and the radiographic manifestations of the tumor were correlated with the occurrence of mediastinal node metastases in 121 patients who had potentially resectable bronchogenic carcinoma. Our results demonstrated that mediastinal metastases occur commonly in patients with central lesions irrespective of cell type, but that the histologic tumor type has a definite influence on the frequency of mediastinal involvement in patients with parenchymal masses or peripheral lesions. Our results also demonstrated that the absence of radiographic evidence of mediastinal involvement cannot be given strong consideration when selecting patients for mediastinoscopy, because almost 50 per cent of patients with mediastinal involvement did not have mediastinal widening on the chest roentgenogram. Our results, in conjunction with currently accepted principles governing the management of patients with bronchogenic carcinoma, have allowed us to propose a logical approach for the use of mediastinoscopy in the prethoracotomy evaluation of patients with potentially resectable lung cancer.