What is a mediastinoscopy

Mediastinoscopy or mediastinoscopy with biopsy, is surgery to look at the inside of your upper chest between and in front of the lungs. This area is called the mediastinum. You will get general anesthesia and be asleep during the mediastinoscopy procedure. Before the mediastinoscopy procedure, you may be given medicine to relax you. You will then get general anesthesia, which will make you sleep. During mediastinoscopy with biopsy, a doctor makes a small cut (incision) in your neck just above the breastbone or on the left side of your chest next to the breastbone. Then your doctor places a thin scope in the opening. A tissue sample (biopsy) can be collected through the mediastinoscope and then looked at under a microscope for lung problems. These problems might include infection, inflammation, or cancer. The most common reason for performing mediastinoscopy is to see if lung cancer (or another cancer) has spread to the mediastinal lymph nodes. This is called staging. Since the 1950s, mediastinoscopy has been the gold standard in evaluating the presence of mediastinal nodal metastases in patients with lung cancer ¹.

Mediastinoscopy is done to:

• Look for problems of the lungs and mediastinum, such as sarcoidosis.
• Diagnose lung cancer or lymphoma (including Hodgkin’s disease). It is often done to check lymph nodes to see if you should have lung removal surgery to treat lung cancer. The test can also help your doctor recommend the best treatment for lung cancer. Treatment may include surgery, radiation, or chemotherapy.
• Diagnose certain types of infection, such as tuberculosis.

In many cases, mediastinoscopy has been replaced by other biopsy methods that use computed tomography (CT), endoscopic ultrasound or bronchoscopy to guide a biopsy needle. Mediastinoscopy procedure may still be needed when the other methods can’t be used or when they don’t show clear results.

Mediastinoscopy procedure

How to prepare for mediastinoscopy

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor if you have any concerns about the need for the test, its risks, how it will be done, or what the results will mean. Be sure to ask what may be done after each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep.

Before you have mediastinoscopy, tell your doctor if you:

• Are taking any medicines.
• Have allergies to any medicines, including anesthetics.
• Take a blood thinner, or if you have had bleeding problems.
• Are or might be pregnant.

Also, certain conditions may make it harder to do mediastinoscopy. Let your doctor know if you have:

• Had this test or open-heart surgery in the past. The scarring from the first procedure may make it hard to do a second one.
• A history of neck problems or a neck injury, especially anything that may have caused your neck muscles to stretch too much, like whiplash.
• Any problems in your chest, including those you’ve had since birth.
• Had radiation treatment to the neck or chest.

You will get general anesthesia and be asleep during the test. To prepare for mediastinoscopy:

• Your doctor will tell you how soon to stop eating and drinking before the test. The surgery may be cancelled if you don’t follow these instructions. If your doctor has told you to take your medicines on the day of surgery, take them with only a sip of water.
• Leave your jewellery at home. Any jewellery you wear will need to be removed before the test.
• Remove glasses, contact lenses, and dentures or a removable bridge just before the test. These will be given back to you as soon as you wake up after the test.
• Arrange to have someone drive you home if you don’t need to stay in the hospital.

Your doctor may order certain blood tests, such as a complete blood count or clotting factors, before your test.

How is mediastinoscopy done?

Mediastinoscopy is done by a chest (thoracic) surgeon in the hospital.

Before the surgery, an intravenous (IV) line will be placed in a vein to give you fluids and medicines. After you are asleep, a tube will be placed in your throat to help you breathe.

The doctor will make an incision just above your breastbone at the base of your neck or on the left side of your chest near the breastbone. The mediastinoscope will be inserted through the opening. Your doctor will look at the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for testing. After the mediastinoscope is taken out, the incision will be closed with a few stitches and covered with a bandage.

A chest x-ray will often be taken at the end of the mediastinoscopy procedure.

Mediastinoscopy procedure usually takes about 60 to 90 minutes. After the test, you will be taken to the recovery room.

Some people may go home if they can swallow fluids without gagging or choking. Others may need to stay in the hospital for 1 or 2 days.

If your stitches are not the dissolving type, you will need to go back to the doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.

In most cases, the result of the biopsy is ready in 5 to 7 days.

If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken to the lab right away. If the lymph nodes show that you have cancer, surgery may be done to remove the cancer while you are still asleep. If the results are not needed quickly, they will usually be ready in 2 to 4 working days.

Abnormal findings may indicate:

• Hodgkin disease
• Lung cancer
• Lymphoma or other tumors
• Sarcoidosis
• The spread of disease from one body part to another
• Tuberculosis

Mediastinoscopy recovery time

After you wake up, you may feel sleepy for several hours. Most people can leave the hospital the next morning.

You may feel tired for a day or two and have some general aches and pains.

You may also have a mild sore throat from the tube that was in your throat. Using throat lozenges and gargling with warm salt water may help.

How you can care for yourself at home

Incision care

• You will have a dressing over the cut (incision). A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
• If you have strips of tape on the cut the doctor made, leave the tape on for a week or until it falls off.
• If you had stitches, your doctor will tell you when to come back to have them removed.
• You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.

Activity

• You can do your normal activities when it feels okay to do so.
• Many people are able to return to work within a few days after this procedure.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

• Be safe with medicines. Read and follow all instructions on the label.
• If your doctor gave you a prescription medicine for pain, take it as prescribed.
• If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you take aspirin or some other blood thinner, be sure to talk to your doctor. He or she will tell you if and when to start taking this medicine again. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.

Mediastinoscopy complications

Complications from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung, a tear in the esophagus, damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness. In some cases, this can lead to bleeding that can be life threatening. To fix the injury, the breastbone would need to be split and the chest opened.

After the mediastinoscopy, contact your doctor right away if you have:

• Bleeding from your stitches.
• A fever.
• Severe chest pain.
• Swelling in the neck.
• Shortness of breath.
• Trouble swallowing.
• Hoarseness of your voice that lasts more than a few days or keeps getting worse.

1. Vyas KS, Davenport DL, Ferraris VA, Saha SP. Mediastinoscopy: trends and practice patterns in the United States. South Med J. 2013;106(10):539–544. doi:10.1097/SMJ.0000000000000000 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387790