Mediastinoscopy: not needed preoperatively in CT-negative lung carcinoma?

The objective was to investigate the necessity of mediastinoscopy in preoperative staging of lung carcinoma in 57 operable patients. Noninvasive radiology was compared to mediastinoscopy and thoracotomy. Computed tomography (CT-scan) and mediastinoscopy were in agreement in 40 cases (70%). CT-scan was negative in 26 patients, of which 4 were false negatives. Mediastinoscopy is therefore of no benefit preoperatively for 85% (22 out of 26) of patients. Consequently, we have changed our staging policy and only patients with positive CT-scan are now subjected to mediastinoscopy.