Mediastinal staging of lung cancer: the changing role of mediastinoscopy.

In order to evaluate the role of mediastinoscopy in determination of resectability in lung cancer, we reviewed retrospectively our experience with this procedure. Of 936 mediastinoscopies performed during the past 22 years, 830 were performed for preoperative evaluation of patients with presumably resectable bronchogenic carcinoma. Metastases in superior mediastinal lymph nodes were found in 295 of 798 patients with histologically proven lung cancer (37%). These patients were spared an unnecessary thoracotomy. There was one death and no other major complications. Computerized tomography of the chest should be performed in all patients with bronchial cancer. If enlarged mediastinal nodes are demonstrated, mediastinoscopy is indicated for histologic evaluation of those nodes and for staging. Mediastinoscopy is a safe and highly reliable procedure with 100% specificity and over 90% accuracy, and is extremely important in staging and predicting resectability in lung cancer. It helps to avoid a futile thoracotomy in patients with incurable disease.