Showing papers on "Mediastinoscopy published in 1983"

Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences

Abstract: Experience with 136 fine-needle aspiration biopsies of mediastinal masses performed in 84 patients is reviewed. Biopsies were performed in all compartments of the mediastinum regardless of age. The biopsy technique included a 22-gauge needle with limitation of needle passes to an arbitrary number of three. The biopsy procedure was guided by either fluoroscopy or computed tomography (CT); guidance by CT is advantageous in the region of the thoracic inlet, hilum, and middle mediastinum, in small mediastinal masses, and in patients with superior vena cava syndrome. In 67 patients (79.7%) a specific cytologic diagnosis was obtained; in seven patients (8.3%), despite the presence of cells in the cytologic specimen, diagnosis could not be assessed. In the other 10 patients (11%), the samples obtained did not contain any cells. Morbidity was low: Light complications occurred in 15 patients (16.6%); drainage of pneumothorax was necessary in only three more. Bronchoscopy provided histology in three patients out of 12, mediastinoscopy established histologic diagnosis in 10 patients out of 16; surgery to remove the mass was performed in 38 patients. It is believed that fine-needle aspiration biopsy should be the first invasive procedure in the workup for diagnosing the nature of a mediastinal mass.

Preoperative staging of lung cancer: accuracy of computed tomography versus mediastinoscopy.

Abstract: Forty-four patients coming to surgery for carcinoma of the bronchus underwent preoperative staging of the mediastinum by computed tomography (CT scanning) and surgical exploration of the mediastinum by cervical mediastinoscopy or left anterior mediastinotomy or both. Where mediastinal nodes were affected the sensitivity and specificity of computed tomography was inferior to that of mediastinoscopy (57% and 85% versus 71% and 100%). The sensitivity of computed tomography in predicting mediastinal invasion was superior to that of mediastinoscopy (77% v 46%), especially in the case of lower-lobe tumours (67% v 17%). Mediastinoscopy had the considerable advantage of 100% specificity. In the assessment of hilar lymphadenopathy computed tomography had a sensitivity of 38% and a specificity of 64%. In cases where computed tomography showed a normal mediastinum or enlargement of the hilar glands only, mediastinal exploration conferred no additional information and could have been omitted. A computed tomography scan showing mediastinal abnormality is an indication for mediastinoscopy and not a contraindication to surgery. In 23 patients computed tomography showed some abnormality of the mediastinum, confirmed at mediastinoscopy in 12 cases. The remaining 11 patients underwent thoracotomy, resection being carried out in nine. Postsurgical staging showed that six of these tumours were N0 lesions without invasion; in two further N0 cases there was a minor degree of mediastinal invasion which did not prevent resection, and the remaining tumour was N1 without invasion.

Cervical mediastinoscopy and anterior mediastinotomy in patients with lung cancer and radiologically normal mediastinum

Abstract: In the period 1975-1980, 1504 patients presented with lung cancer, 291 were presumably operable, and had no radiological evidence of mediastinal lymph node invasion. Two thirds (192 patients) underwent pre-operative surgical mediastinal exploration, and one third (99 patients) were operated right away. Of the 162 cervical mediastinoscopies, 16% had lymph node invasion (19.7% with right-sided, 10.6% with left-sided tumor); 28.9% of the 45 left-anterior mediastinotomies were positive. There was only one positive cervical mediastinoscopy of 46 cases with lower-lobe tumor, and no positive anterior mediastinotomy in 5 cases with left lower-lobe tumor. Mediastinal exploration yields, thus, a relatively higher percentage of positive results if the cervical mediastinoscopy is restricted to tumors affecting the right upper and middle lobes (25%), and if the anterior mediastinotomy is restricted to the left upper lobe (32.5%). A left anterior mediastinotomy should, thus, be recommended instead of cervical mediastinoscopy for tumors of the left upper lobe.

57Co-bleomycin and 67Ga-citrate in detecting and staging lung cancer.

Abstract: In the investigation of suspected lung cancer bleomycin labelled with cobalt-57 and gallium-67 labelled with citrate are currently used to detect the primary tumour and to establish the presence of metastases in the lung hilum and mediastinum. A comparative study of these radio-pharmaceuticals was performed in 63 patients with proved lung cancer. 57Co-bleomycin showed the primary tumour in 58 patients (92%) and 67 Ga-citrate in 34 (54%) (p less than 0.01). The average tumour-to-lung ratio was 3.4 with 57Co-bleomycin and 1.5 with 67Ga-citrate. Proved metastases in the hilum or the mediastinum were visualised with 57Co-bleomycin scintigraphy in 16 out of 18 patients (89%) and with 67 Ga-citrate scintigraphy in only eight (45%) (p less than 0.01). These results indicate that 57Co-bleomycin scintigraphy is more suitable for detecting and staging lung cancer than is 67Ga-citrate. 57Co-bleomycin is valuable in the detection of peripheral lesions, in which a pathological diagnosis is difficult to achieve, since a positive scintigram indicates malignancy. When 57Co-bleomycin scintigraphy suggests hilar or mediastinal metastases mediastinoscopy should be carried out; but when no metastases are apparent it is reasonable to proceed directly to thoracotomy without mediastinoscopy.

Computed tomography in carcinoma of esophagus and cardia.

Abstract: CT scanning was performed on 36 patients with carcinoma of the esophagus or cardia. In a retrospective study, staging of esophageal malignancy, obtained by CT, was correlated with clinical data as well as endoscopic, bronchoscopic, operative, and/or autopsy findings. The results indicated that CT is a useful method for pretherapeutic staging in carcinoma of the esophagus and cardia and should be routinely performed in conjunction with conventional x-ray examination and esophagoscopy. The use of mediastinoscopy and diagnostic surgical procedures such as exploratory thoracotomy and laparotomy can be reduced.

Technetium-99m glucoheptonate imaging in lung cancer and benign lung disease: concise communication.

Abstract: We prospectively studied technetium-99m glucoheptonate (Tc-GHA) uptake in 58 patients with newly diagnosed lung cancer and in 20 patients with pulmonary inflammatory disease or metastatic carcinoma. Fifty-three (91%) primary tumors accumulated Tc-GHA: squamous cell 20/22, adenocarcinoma 7/7, large cell 10/11, and small cell 16/18. Intensity of tumor uptake was greatest in small-cell cancer. Supraclavicular metastases were detected in two patients. Fourteen patients with mediastinal evaluation by Tc-GHA imaging and trispiral tomography underwent mediastinoscopy or thoracotomy. Five of ten patients with negative mediastinum by tomography and Tc-GHA imaging showed metastases by biopsy (false-negative Tc-GHA). Less intense accumulation of Tc-GHA was observed in 18/20 cases of pulmonary inflammatory disease or pulmonary metastases. Although Tc-GHA accumulates by an unknown mechanism in primary lung cancer, we cannot recommend its use in detecting mediastinal spread of lung cancer due to its unacceptably high false-negative rate.

Associated lung lesions in patients with primary head and neck carcinoma.

Abstract: From a 9-year Veterans Administration Medical Center experience, 34 patients were identified who had synchronous or metachronous pulmonary lesions in association with primary head-neck carcinoma. Evaluation of the pulmonary lesions included bronchoscopy, mediastinoscopy, and thoracotomy. Lung lesions were felt to be metastatic lesions from head and neck primary in 12 patients, primary lung carcinoma in 20 patients, and metastases from subdiaphragmatic primary neoplasms in two patients. This study demonstrates that head-neck carcinoma may spread to the lung but that associated lung lesions are most commonly second primary neoplasms.

Excision of mediastinal parathyroid gland by mediastinoscopy.

Abstract: Mediastinal parathyroid tissue continues to be a significant problem in patients with recurrent or persistent hypercalcemia after parathyroid surgery. In two such cases, we used mediastinoscopy to locate and remove mediastinal parathyroid glands, thus avoiding the morbidity of median sternotomy.

The value of radiographic and computed tomography in the staging of lung carcinoma

Abstract: A prospective double-blind study was undertaken to compare computed tomography (CT) and conventional radiographic tomography (RT) in the staging of lung carcinoma. Seventy-five patients had CT and RT of the mediastinum and hilum prior to operation. The presence or absence of metastasis to lymph nodes documented at the time of operation was the standard applied to the studies. CT correctly predicted the presence or absence of mediastinal lymphadenopathy in most cases (sensitivity 91%, specificity 94%), while RT was less helpful (sensitivity 61%, specificity 86%). Metastatic mediastinal lymph nodes in those patients with false negative CT and RT studies averaged only 0.8 cm in diameter, probably accounting for the negative radiographic findings. Both CT and RT had poor predictive values in detecting hilar lymphadenopathy (sensitivity 73% and 47%, specificity 87% and 72%, respectively). The predictive value of CT in the evaluation of mediastinal lymphadenopathy equaled that of mediastinoscopy or mediastinotomy. When CT of the mediastinum demonstrates no lymphadenopathy, invasive staging can be deferred for definitive thoracotomy. Since false positive values were seen with both CT and RT scans of the mediastinum (4% and 8%, respectively), invasive staging will still be necessary in those patients with positive studies.

Diagnosing coccidioidomycosis outside an endemic area. A recent case in Montreal, Quebec, Canada.

Abstract: A 65-year-old female with a long-standing controlled Crohn's disease was admitted in August 1979 to a Montreal hospital for investigation of a non-calcified RUL lung nodule. After an extensive work-up (negative bronchoscopy and mediastinoscopy showing a granulomatous reaction) she underwent thoracotomy; the nodule was enucleated and showed caseous material within a fibrous capsule.

Obstruction respiratoire peranesthésique en cas de lymphome malin médiastinal

Abstract: Three cases of asphyxia at the beginning of general anaesthesia for mediastinoscopy or biopsy of adenopathy are described in patients with malignant lymphoma. One of them died in spite of endobronchial intubation, artificial ventilation and steroids. The two others recovered when specific chemotherapy was added to the same symptomatic treatment. The risk of respiratory obstruction seems higher in non-Hodgkin than in Hodgkin lymphomas. This kind of obstruction is not relieved by an antiasthmatic therapy. Pulmonary lymphatic filtration may be hindered in case of mediastinal lymphoma, especially during anaesthetic induction, and pulmonary interstitial congestion may occur impeding gas propagation. Specific chemotherapy according to the histological type of the tumour may relieve the compression and respiratory obstruction in a few hours.

55 degrees posterior oblique tomography of the pulmonary hilum in the evaluation of lung tumors.

Abstract: Findings at 55 degrees posterior oblique tomography and chest films were compared to those at thoracotomy in 53 patients with malignant lung tumor. A correct evaluation of presence of lymph node metastases was made by tomography in 44 of the patients. Lack of tissue diagnosis at tomography makes mediastinoscopy better as a staging procedure. Oblique hilotomography is mainly indicated as a method for accurate evaluation of the questionably large hilum.

The value of cervical mediastinoscopy.

Abstract: The reliability of mediastinoscopy as described by Carlens was evaluated in 170 patients with lung cancer. When the primary tumour was located in the left upper lobe, the result of the mediastinoscopy was false-negative in 12 (31%) out of 39 patients. Other invasive procedures, such as left parasternal mediastinoscopy, might be more accurate in these patients.

Effects of steroid therapy on pulmonary involvement in sarcoidosis.

Abstract: In eleven patients with stage II-III pulmonary sarcoidosis as assessed by mediastinoscopy or open lung biopsy, we carried out a functional study by evaluating static and dynamic pulmonary volumes, diffusing lung properties (TLCO, KCO), and mechanical properties: resistance of the airway, flow-volume curve, pressure-volume curve, flow-pressure curve, and dynamic compliance. In 7 of 11 patients a clinical and functional follow-up during steroid treatment over a period of 5 months to 3 years was also performed. Before treatment diffusing properties were in the normal range in 6 of 11 subjects, reduced in 4, and increased in 1. Elastic properties studied in 8 patients were in the normal range, whereas peripheral airway involvement was noted in 4 nonsmokers. During the follow-up the changes noted in diffusing lung properties on the whole parallelled the clinical and radiologic improvement or relapses after cessation of therapy. In contrast, no changes in elastic properties or lung volume were noted. We concluded that steroid treatment seems to improve parenchymal lung involvement in most cases as shown by the increase in diffusing lung properties.

Preoperative staging oflung cancer: accuracy of

Abstract: Forty-four patients comingtosurgeryforcarcinoma ofthebronchus underwent preoperative staging ofthemediastinum bycomputed tomography (CTscanning) andsurgical exploration ofthemediastinum bycervical mediastinoscopy orleft anterior mediastinotomy or both.Wheremediastinal nodeswere affected thesensitivity andspecificity ofcomputed tomography was inferior tothatofmediastinoscopy (57%and85%versus71%and100%). The sensitivity ofcomputed tomography inpredicting mediastinal invasion was superior tothatof mediastinoscopy (77%v 46%),especially inthecaseoflower-lobe tumours(67%v 17%). Mediastinoscopy hadtheconsiderable advantage of100%specificity. Intheassessment ofhilar lymphadenopathy computed tomography hadasensitivity of38%andaspecificity of64%.Incases wherecomputed tomography showed a normal mediastinum orenlargement ofthehilar glands only, mediastinal exploration conferred no additional information andcould havebeenomitted. A computed tomography scanshowing mediastinal abnormality isanindication formediastinoscopy andnota contraindication tosurgery.In23patients computed tomography showedsome abnormality ofthemediastinum, confirmed atmediastinoscopy in12cases.Theremaining 11 patients underwent thoracotomy, resection being carried outinnine. Postsurgical staging showed that sixofthese tumourswereNolesions without invasion; intwofurther Nocasesthere was aminor degree ofmediastinal invasion whichdidnotprevent resection, andtheremaining tumourwasN, without invasion. Surgical exploration of themediastinum using cervical mediastinoscopy, supplemented in left upper-lobe tumoursbyleft anterior mediastinotomy, hasbecomean established staging procedure before thoracotomy. Somedissatisfaction withthis invasive procedure, however, andtheincreasing useofcom- putedtomography forvisualising themediastinum ledustocarryoutaprospective study toevaluate the accuracyofthese twotechniques inthepreoperative staging oflung cancer.