Efficacy of Mediastinoscopy in Patients With Isolated Mediastinal Lymphadenopathy

Background: Since its introduction in 1959 by Carlens (1), Mediastinoscopy has been, for long, used for assessment of the mediastinum (superior and middle) for establishing a histological diagnosis of mediastinal masses of undefined cause, and for Lung carcinomas staging. The use of Mediastinoscopy has been decreasing lately due to the introduction of other less invasive techniques (e.g., endoscopic ultrasound-directed fine needle aspiration cytology), however, it is still a cheap and effective tool that can be utilized in underprivileged centers. Objective: To emphasize how does Mediastinoscopy plays an important role in confirming the clinical diagnosis of isolated mediastinal lymphadenopathy and reviewing its utility. Methods: These are a retrospective analysis of medical charts for patients who underwent diagnostic cervical mediastinoscopy during (2012 – 2018) at a University hospital in Saudi Arabia. The included patients are presented with an isolated mediastinal lymph node enlargement, in the absence of underlying cause and was found to be significant (>1cm in its short axis) by computed tomography. The patient who had a known cause (e.g., Sarcoidosis) or were diagnosed via other tools, was excluded. Results: Mediastinoscopy was performed on 56 patients, 38 of them were males (68%) and 18 females (32%), with a mean age of (37.5 ± 10 years). The patients' most common presenting symptoms were persistent cough (49%), fever of unknown origin (38%) and weight loss (36%) with an average of 2 symptoms per patient, while in 4 patients (7%) lymphadenopathy was discovered incidentally during the CT scan for other reasons. In addition, the histopathological examination of specimens obtained confirmed the most common diagnoses, Sarcoidosis in 17 patients (30%), lymphoma in 12 patients (21%) and TB in 10 patients (18%). The mean hospital stay (calculated from the day of the procedure) was (2.5 ± 4 days) including work up, with only one mortality (2%) and 3 patients (5%) had experienced post-operative complications. Conclusion: The diagnostic Mediastinoscopy is both safe and efficient in the diagnosis of patients with isolated mediastinal lymphadenopathy, requiring a minimal surgical setup and is considered cost-effective. Therefore, it is a valid choice of investigating such cases in other underprivileged centers, as it reaches a tissue-based diagnosis, while other techniques are used for staging purposes.