Transcarinal mediastinal needle biopsy compared with mediastinoscopy.

A total of 183 patients with abnormalities on the chest roentgenogram were examined by bronchoscopy in conjunction with transcarinal mediastinal needle biopsy and mediastinoscopy to investigate the agreement between these methods regarding possible metastases. In 37 of the 159 patients with malignant pulmonary lesions, needle biopsy demonstrated metastases in the subcarinal lymph nodes. Mediastinoscopy had the same percentage of positive findings in the subcarinal nodes, but there was only agreement between the two methods in 20 cases. Transcarinal mediastinal needle biopsy as a supplement to conventional bronchoscopy is applicable in the outpatient evaluation of patients with malignant bronchial lesions as a screening for further examination. The method does not carry complications of any kind. Positive biopsy results, combined with other clinical findings, can at times spare the patient a mediastinoscopy. On the other hand, an adequately indicated needle biopsy which yields negative findings should always be followed by mediastinoscopy. In the planning of treatment for patients with malignant lesions of the lungs, it is of decisive importance to evaluate the dissemination of the tumor to the mediastinal structures, primarily to the subcarinal and the contralateral lymph nodes.