Mediastinoscopy: Surgical Versus Medical

Abstract

Mediastinal lymph node assessment is an integral part of lung cancer staging. Information regarding status of mediastinal lymph nodes has prognostic value and directs lung cancer management. Given relatively low sensitivity and specificity of noninvasive staging modalities (CT chest and PET scan), invasive mediastinal lymph node staging is required in a significant proportion of patients prior to lung cancer management. This chapter will provide an in-depth, evidence-based overview of invasive mediastinal staging modalities and their diagnostic performance and complications and will offer a historical perspective on evolution of clinical practice of invasive mediastinal lymph node staging from the era dominated by surgical approaches (including cervical mediastinoscopy and Chamberlain’s procedure) to the modern-day mediastinal lymph node assessment with minimally invasive, needle-based techniques of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In addition, this chapter will offer a guide to the use of staging techniques in the modern era and discuss the role of multidisciplinary teams, focusing on the role of thoracic surgery and interventional pulmonology, in mediastinal lymph node staging in lung cancer.