Mediastinoscopy in the Diagnosis of Pleural Mesothelioma Cancer

Mesothelioma News

Use of Mediastinoscopy to Determine Whether Mesothelioma Cancer Tumors Have Spread

July 3, 2003 — Researchers at the Netherlands Cancer Institute recently studied the use of mediastinoscopy to determine if mesothelioma cancer tumors have spread (Ann Thorac Surg. 2003 Jun; 75(6): 1715–8). A mediastinoscopy is a method of looking at the tissues and organs in the mediastinum, which is the chest cavity behind the breastbone that lies between the lungs. First, a tube is inserted in the trachea. Next, the surgeon makes an incision in the chest, inserting a narrow tube or mediastinoscope. The lighted mediastinoscope allows the surgeon to insert tools to collect tissue samples.

The purpose of the mediastinoscopy is to show whether mesothelioma cancer tumors have spread to the mediastinal nodes (the lymph nodes in the mediastinum). This is an important determination because mesothelioma patients with localized pleural mesothelioma can be considered for major surgery that may prolong their lives in some cases (see discussion of Mesothelioma Surgery, Extrapleural Pneumonectomy). However, the surgery is not appropriate if the tumors have spread.

Comparison of Mediastinoscopy with CT Scanning in Diagnosing Pleural Mesothelioma

Computer tomography (CT) scanning is a radiographic technique that uses a computer to combine multiple x–ray images into a two–dimensional cross–sectional image. The researchers compared mediastinoscopy with CT scanning as a diagnostic method using 43 pleural mesothelioma patients. Computer tomography and mediastinoscopy results were also interpreted based on final histology samples obtained at surgery, if this was later performed. Not all mediastinum areas were visible or biopsied with mediastinoscopy. Among those viewable areas, the sensitivity, specificity, and accuracy of tumor detection using mediastinoscopy was considerably better than for CT scanning. The mediastinoscopy figures were 80%, 100%, and 93% for sensitivity, specificity, and accuracy, as compared with 60%, 71%, and 67% for CT scanning.

According to the researchers’ interpretation, the results of mediastinoscopy were more reliable than those obtained by CT scanning. They also pointed out that previous studies showed that mediastinal lymph node problems were frequent in pleural mesothelioma.

Complications of Mediastinoscopy

Mediastinoscopy is not without its potential complications. These include general risks from anesthesia. Problems with damage to internal organs, infection, and bleeding are possible, although they are not common (see Merck Manual, Mediastinoscopy).