When a client is scheduled for a mediastinoscopy

What Is Mediastinoscopy with Biopsy?

A mediastinoscopy with biopsy is a minor surgical procedure that gathers samples of lymph nodes. Lymph nodes are clusters of cells that play a key role in fighting off viruses and bacteria in your body. A surgeon takes the tissue sample from your chest.

A surgeon inserts a small instrument with a light—called a mediastinoscope—through an incision in your throat. They run it under your sternum (breastplate) and move it into the area between your lungs. You’ll be under general anesthetic during the biopsy.

The test looks for any abnormalities and takes one or more small tissue samples, called biopsies. Lab technicians examine and assess the biopsies in a lab. This test commonly checks for cancer.

Your doctor might order a mediastinoscopy with biopsy for several reasons. They may want to:

• see if a cancer in the lung has spread to the lymph nodes
• check for other lymphatic cancers, including Hodgkin’s disease or lymphoma
• identify infections, such as tuberculosis

Doctors often use mediastinoscopy to understand how far lung or other cancers have advanced. This is also known as staging the cancer, or determining what stage your cancer has reached. This information can help you and your doctor select the most appropriate course of treatment.

Doctors base the stage of any type of cancer on several factors. These include:

• the size of the primary tumor
• whether the cancer is present in distant parts of the body
• whether the lymph nodes are involved

A surgical team will perform your mediastinoscopy in a hospital or outpatient surgical center.

You shouldn’t eat or drink anything after midnight on the day before your test if you are advised not to. Make sure to arrive at the surgery site at the scheduled time.

After you check in, you will be taken to a private room or cubicle, where you will be asked to remove your clothing and jewelry and put on a hospital gown (it may be a good idea to leave jewelry at home to prevent loss). The nurse will then start an IV in your hand, wrist, or arm. You may feel a short, sharp pain when the nurse inserts the needle, but the discomfort will fade quickly. The nurse will tape the IV in place so that you don’t accidentally remove it.

When it’s time for your procedure, a nurse or technician will take you into the operating room on a cot with wheels, called a gurney.

Once you’re in the operating room, you will lie on your back on the operating table. An anesthesiologist will then inject a medication into your IV that will put you into a deep sleep. You won’t feel pain during the procedure. Once you’re unconscious, the doctor will place a flexible tube into your mouth and maneuver it into your lungs to help you breathe.

The surgeon will then make an incision at the base of your throat and thread the mediastinoscope into the space between your lungs.

They’ll examine the area visually. The surgeon will also remove a small piece of tissue from the lymph nodes and from any other area that looks inflamed, infected, or otherwise abnormal.

When this process is complete, the surgeon will withdraw the mediastinoscope, remove the breathing tube from your lungs, and stitch the incision closed. The tissue samples will go to the laboratory for analysis.

You will wake up in the recovery room. The staff there will offer you pain medications and monitor your vital signs to make sure they remain stable. If you don’t suffer any complications, you can go home within a few hours.

Your throat will probably feel swollen and tender for a few days, and it may hurt to talk or swallow. Talk to your doctor about the best medications to manage any pain.

Any time you receive general anesthesia, you run a slight risk of an allergic reaction to the medication. This can lead to difficulty in breathing.

The most serious risk during this surgery is the accidental puncture of blood vessels, which could lead to a hemorrhage which can be fatal. This complication, however, is exceedingly rare.

When doctors look at the biopsies, they will study the size and shape of the cells in your tissue. This will determine whether they are normal (benign) or malignant (cancerous). This type of molecular cell study is called cytology.

If the problem is an infection, they will culture the tissue to identify the microorganisms present and select the best medications to treat it.

A mediastinoscopy is a surgical procedure performed to examine the area within the thoracic cavity known as the mediastinum, specifically the space between the lungs and behind the breastbone.

Doctors may order this test if they suspect cancer in or around the lungs, such as non-small cell lung cancer, or need to learn more about the spread of existing cancer.

Mediastinoscopy is named after both the mediastinum and the tool used to visualize it, a scope. The scope is a flexible, thin tube with a tiny video camera that transmits images to a computer screen. Placing the scope into the mediastinum allows a doctor to look for signs of cancer and take a tissue sample or remove a lymph node for further testing.

A mediastinoscopy may be recommended for many reasons, including:

• To visualize lymph nodes or masses that may be cancerous
• To take a biopsy, or tissue sample, from a tumor or to remove the mass itself, along with any suspicious lymph nodes
• To diagnose Hodgkin and non-Hodgkin lymphomas and mesothelioma

Other types of masses may be treated during a mediastinoscopy, such as:

• Thyroid tumors
• Parathyroid tumors
• Esophageal tumors
• Neurogenic tumors
• Thymoma
• Cysts
• Aneurysms
• Other blood vessel abnormalities

Typically, a mediastinoscopy is performed only once because of the scar tissue it may create.

Before the procedure, your care team may ask about all current medications—including prescription medicines, supplements, vitamins and over-the-counter drugs. They’ll also want to know about any allergies.

Other steps leading up to the mediastinoscopy may involve discontinuing the use of blood-thinning medicine, for example, and limiting food and drink on the morning of the procedure.

A mediastinoscopy is performed in a hospital operating room and typically takes 60 to 90 minutes. It’s usually an outpatient procedure, so most patients don’t need to spend the night in the hospital. Because the use of general anesthesia is likely, however, patients may need to make arrangements for a ride home to avoid driving afterward.

In addition to the anesthetic, the procedure involves administering an IV, or intravenous infusion. Then a tube, connected to a machine that breathes for the patient, is placed in the throat. Next, the surgeon makes a small incision just above the breastbone and inserts the mediastinoscope into the chest cavity. (At some surgical centers, robotics are used as part of the procedure to help insert and direct the scope.)

Depending on the reason for the mediastinoscopy, the surgeon may visualize the area, take computer images, take tissue samples and/or remove any masses. Once the procedure is completed, the surgeon removes the mediastinoscope and closes the incision with stitches. Sometimes, a chest X-ray is taken at this point.

A mediastinoscopy is performed by a skilled surgeon, such as a cardiothoracic surgeon, trained not only in the procedure but also in handling complications that may arise.

During recovery, a patient may feel sore for a few days and experience temporary hoarseness or have a mild sore throat.

In general, it’s a good idea to:

• Rest and avoid any exercise or heavy lifting for the first week
• Know how to wash and care for the incision site
• Schedule an appointment to have the stitches removed

Also, a patient should closely monitor for any warning signs of a complication and immediately call the doctor in the event of symptoms.

These may include:

• Difficulty breathing
• Blood in the sputum or mucus
• Persistent fever
• Sharp pain

After the procedure, a follow-up appointment may be scheduled to check on the incision and review the results. This review may also be used to refine an ongoing treatment plan.

A mediastinoscopy is an operation that comes with some possible complications. Bleeding is the most serious one, especially if it occurs in a main blood vessel. There are also risks to the airways and certain nerves. Some patients may experience pneumonia, a partially collapsed lung or an infection at the incision site.