Naylor A R, Elliott R C, Walker W S, Lamb D, Cameron E W, Dark J
Department of Thoracic Surgery, City Hospital, Edinburgh, UK.
J R Coll Surg Edinb. 1990 Apr;35(2):98-100.
In order to assess the diagnostic efficiency of mediastinoscopy in patients with undiagnosed mediastinal masses, a retrospective review was undertaken of the results obtained in a consecutive series of 42 patients presenting over a 5-year period. In 28 (67%) patients, a tissue diagnosis was made. Ten (24%) patients underwent a negative mediastinoscopy but were found to have significant pathology on further investigation (eight in a location outside the range of conventional mediastinoscopy). Four (10%) patients had negative findings and were confirmed to have no significant pathology on further investigation and follow-up. Overall, mediastinoscopy had a sensitivity of 74%, a specificity of 100% and an accuracy of 76%; however, for lesions within the range of mediastinoscopy, the sensitivity was 93%, the specificity 100% and the accuracy 94%. The predictive value of a negative examination was 66%. Mediastinoscopy is a valuable technique in the diagnosis of mediastinal masses but, because of the low predictive value of a negative examination, further evaluation, including thoracotomy if necessary, is still indicated if mediastinoscopy is unhelpful.
为评估纵隔镜检查对纵隔肿物未确诊患者的诊断效率，我们对连续5年收治的42例患者的检查结果进行了回顾性分析。28例（67%）患者获得了组织学诊断。10例（24%）患者纵隔镜检查结果为阴性，但进一步检查发现有明显病变（8例病变部位不在传统纵隔镜检查范围内）。4例（10%）患者检查结果为阴性，进一步检查及随访证实无明显病变。总体而言，纵隔镜检查的敏感性为74%，特异性为100%，准确性为76%；然而，对于纵隔镜检查范围内的病变，敏感性为93%，特异性为100%，准确性为94%。阴性检查的预测值为66%。纵隔镜检查是诊断纵隔肿物的一项有价值的技术，但由于阴性检查的预测值较低，如果纵隔镜检查无帮助，仍需进一步评估，必要时包括开胸手术。
