Role of mediastinoscopy in superior vena cava obstruction.

BACKGROUND: The role of mediastinoscopy in superior vena cava obstruction (SVCO) is not clearly defined. The authors set out to examine the efficacy and safety of mediastinoscopy in SVCO. METHODS: They reviewed 14 patients referred to one surgical team over an 8-year period (1982-1990) who required mediastinoscopy to establish a histologic diagnosis after other less invasive procedures had not established the diagnosis. RESULTS: Of the 14 patients, 11 had lung cancer, 2 had lymphoma, and 1 had malignant thymoma. Definitive tissue diagnosis was obtained in 13 cases. Mediastinoscopy was unsuccessful in one of the cases because no pathologic tissue could be identified at the time of the procedure. Tissue diagnosis could only be obtained in this patient after mediastinotomy, and a lymphoma was found. There was one complication of mediastinoscopy; one patient had arterial bleeding from the innominate artery that required limited sternotomy to control the bleeding. CONCLUSIONS: The authors believe that mediastinoscopy is a safe and effective technique for establishing a histologic diagnosis in SVCO when less invasive techniques have been unsuccessful. The use of blind radiation therapy cannot be justified on an emergency basis; failure to obtain a histologic diagnosis will result in up to 20% of patients receiving inappropriate radiation therapy, making subsequent tissue diagnosis very difficult.