MEDIASTINOSCOPY: A METHOD OF BIOPSY IN THE SUPERIOR MEDIASTINUM.

SUMMARY Mediastinoscopy, a method for exploration and biopsy in the superior mediastinum, is a widely employed technique in Scandinavia and Europe, but has received little attention to date in North America. The technique of operation is reviewed briefly and an analysis of the results of mediastinoscopy in 67 patients at the Toronto General Hospital is presented. It appears reasonable to consider mediastinoscopy as the last step in the preoperative assessment of all patients with presumably operable bronchial carcinoma, since superior mediastinal extension of disease will be demonstrated in approximately 1 of every 3 patients. In some patients it will be shown that resection is not technically possible, and useless thoracotomy will be avoided. In others, the finding of involved subcarinal or paratracheal nodes may modify the particular surgeon's decision about radical pneumonectomy, or the use of pre- or postoperative radiotherapy. In the author's opinion, patients with involved paratracheal nodes are best treated by nonsurgical means, unless a distinct indication for palliative resection exists. It is concluded that the operation is safe, relatively simple, and decidedly useful, both for the assessment of operability and resectability in bronchial carcinoma and for establishing a tissue diagnosis in certain intrathoracic lesions.