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Mediastinoscopy

Test Overview

Mediastinoscopy is a surgical procedure to examine the inside of the upper chest between and in front of the lungs (mediastinum).

During a mediastinoscopy, a small cut (incision) is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope (mediastinoscope) is inserted through the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then examined under a microscope for lung problems, such as infection, inflammation, or cancer. See a picture of mediastinoscopy.

In many cases mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle to the abnormal tissue. Mediastinoscopy may still be needed when these methods cannot be used or when they do not provide conclusive results.

Why It Is Done

Mediastinoscopy is done to:

  • Detect problems of the lungs and mediastinum, such as sarcoidosis.
  • Diagnose lung cancer or lymphoma (including Hodgkin's disease). Mediastinoscopy is often done to check lymph nodes in the mediastinum before considering lung removal surgery to treat lung cancer. Mediastinoscopy can also help your doctor recommend the best treatment (surgery, radiation, chemotherapy) for lung cancer.
  • Diagnose certain types of infection, especially those that can affect the lungs (such as tuberculosis).

How To Prepare

You will be asked to sign a consent form before mediastinoscopy. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. Be sure to discuss with your doctor what may be done following each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep. To help you understand the importance of this procedure, fill out the medical test information form(What is a PDF document?).

Before you have a mediastinoscopy, tell your doctor if you:

  • Are taking any medicines.
  • Have allergies to any medicines, including anesthetics.
  • Have any bleeding problems or take blood thinners, such as aspirin, warfarin (Coumadin), or clopidogrel (Plavix).
  • Are or might be pregnant.

Also, certain conditions may make it more difficult to do a mediastinoscopy. Let your doctor know if you have:

  • Had a mediastinoscopy or open-heart surgery in the past. The scarring from the first procedure may make it difficult to do a second procedure.
  • A history of neck problems or a neck injury, especially hyperextension of the neck.
  • Any physical problems of your chest, including those that have been present since birth (congenital).
  • Recently had radiation therapy to the neck or chest.

You will receive general anesthesia and be asleep during the mediastinoscopy. To prepare for your procedure:

  • Your doctor will tell you how soon before the procedure to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
  • Leave your jewelry at home. Any jewelry you wear will need to be removed before the procedure.
  • Remove glasses, contact lenses, and dentures or a removable bridge just prior to the procedure. These will be given back to you as soon as you wake up after the procedure.
  • Arrange to have someone drive you home after the procedure if you do not need to stay in the hospital.

Your doctor may order certain blood tests, such as a complete blood count or clotting factors, before your procedure.

How It Is Done

Mediastinoscopy is done by a chest (thoracic) surgeon and surgical assistants.

Before the procedure, an intravenous (IV) line will be placed in a vein to give you fluids and medicines. After you are asleep, a tube will be placed in your throat (endotracheal or ET tube) to help you breathe during the procedure. Your neck and chest will be washed with an antiseptic soap and covered with a sterile drape.

An incision will be made just above your breastbone at the base of your neck or on the left side of your chest near the breastbone between the 4th and 5th ribs. The mediastinoscope will be inserted through the opening. Your doctor will examine the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for examination. After the scope is removed from your chest, the incision will be closed with a few stitches and covered with a bandage.

The entire procedure usually takes about an hour. After the procedure, you will be taken to the recovery room.

Some people may go home after the procedure if the general anesthesia wears off and they are able to swallow fluids without gagging or choking. Other people may need to stay in the hospital for 1 or 2 days. If your stitches are not the dissolving type, you will need to return to your doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.

How It Feels

Before the procedure, you may be given medicine that will make you sleepy and relaxed. You will receive general anesthesia during the mediastinoscopy, which will cause you to be asleep. After you wake up, you may feel sleepy for several hours. You may feel tired for 1 to 2 days after the procedure and have some general aches and pains. You may also have a mild sore throat from the tube in your throat during the procedure. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks

Complications from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung (pneumothorax), a tear in the esophagus, damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness.

After the procedure, contact your doctor immediately if you have:

  • Bleeding from your stitches.
  • A fever.
  • Severe chest pain.
  • Swelling in the neck.
  • Shortness of breath.
  • Difficulty swallowing.
  • Hoarseness of your voice that lasts more than a few days or continues to get worse.

Results

Mediastinoscopy is a surgical procedure to examine the inside of the chest between and in front of the lungs (mediastinum).

Mediastinoscopy

Normal:

Lymph nodes are small, smooth, and appear normal.

No abnormal tissue, growths, or signs of infection are present.

Abnormal:

Lymph nodes may be enlarged or appear abnormal, which may indicate sarcoidosis, infection, or cancer. Tissue samples are removed and examined under the microscope.

Abnormal growths (such as a tumor) or signs of infection (such as an abscess) may be found in the chest cavity, or mediastinum.

What Affects the Test

If you have had mediastinoscopy or open-heart surgery, you may not be able to have this procedure. Scarring from the first procedure may make it difficult to do a second procedure.

What To Think About

If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken immediately to the laboratory. There it will be frozen and sliced into very thin sections for examination under a microscope. If the lymph nodes show that you have cancer, surgery may be done right away to remove the cancer while you are still asleep. If a frozen section sample is not needed, a permanent section is made and the results usually are available in 2 to 4 working days.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
Last Revised March 18, 2011

Last Revised: March 18, 2011

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology

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