Mediastinoscopy as a diagnostic tool in a South African tertiary hospital

Abstract

Background: Mediastinoscopy is an effective and safe diagnostic tool for anterior mediastinal lesions. The study was done to assess the usefulness of mediastinoscopy as a diagnostic modality for mediastinal lesions.
Methods: A retrospective study of patients who had mediastinoscopy over 12 years at the Groote Schuur Hospital, Cape Town. Preoperative data, intraoperative and postoperative data were collected.
Results: The records of 115 patients were reviewed. Male to female ratio was 1.4:1 with a mean age of 48.5 (± 16.8) years. Preoperative computerised tomography (CT) scan was done in 98.3%. The most common indications for mediastinoscopy were mediastinal lymphadenopathy (87.8%) and anterior mediastinal mass (12.2%). Prior endobronchial ultrasound (EBUS) biopsy was done in 11.3%. All the patients had conventional cervical mediastinoscopy. Lung cancer staging accounted for 16.5% of the procedures. A biopsy was successfully done in 103 patients (89.6%). The most common
lymph node station biopsied was 2R (55.7% of 76 patients), though the information on stations biopsied could not be ascertained in 25.2% of patients. The complication rate was 1.7 % (suprasternal haematoma and brachiocephalic artery injury). Histopathologic diagnoses were obtained in 89.5% (103/115 patients). Benign diagnoses accounted for 72.8% (75), while malignant diagnoses were 27.2% (28). Intensive care unit (ICU) stay and mechanical ventilation were required in 5% and 2.5% of patients, respectively. The median postoperative hospital stay was 2 days. There were no postoperative
deaths. The median follow-up period was 14 days.
Conclusion: Mediastinoscopy’s diagnostic role is assured, still required and is safe with minimal morbidity and no mortality.