The Journal of Thoracic and Cardiovascular Surgery, Vol 71, 768-773, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
The selection of patients with bronchogenic carcinoma for mediastinoscopy
CM Hutchinson
The records of 112 patients treated at the Ochsner Foundation Hospital with
the diagnosis of bronchogenic carcinoma were reviewed. A new concept for
defining the location of central versus peripheral tumors is presented.
Criteria important in selection of patients for whom mediastinoscopy is
likely to be helpful are cell type, location (peripheral versus central),
and radiographic evidence of mediastinal metastasis. The size of the tumor
is not a useful criterion except possibly for squamous cell lesions. A high
incidence of mediastinal metasis was found associated with central tumors
(63 to 100 per cent) of all cell types and with peripheral lesions (63 per
cent) of undifferentiated cell types. A relatively low incidence of
mediastinal metasis was associated with peripheral asenocarcinomas or
squamous cell tumors. We would, therefore, recommend mediastinoscopy for
all patients with central lesions and those patients with peripheral
lesions of an undifferentiated cell type. When correlated with radiographic
findings, only 4.6 per cent of peripheral carcinomas of a differentiated
cell type with a radiographically normal mediastinum were found to produce
mediastinal metastases, and mediastinoscopy is not recommended. In patients
with peripheral tumors of indeterminate cell type, a decision for
mediastinoscopy may be influenced by other factors such as the operative
risk of a thoracotomy and location of the primary tumor within the lung.
