İbrahim Can KÜRKÇÜOĞLU, İsmail Cüneyt KURUL, İsmail DEMİRCAN, Cemil Deniz YORGANCILAR

Tanısal mediastinoskopi: 30 olgunun analizi

Amaç: Bu çalışmada, diğer tanısal yöntemlerle adlandırılamayan mediastinal lezyonlu otuz olguda uygulanan tanısal amaçlı mediastinoskopik girişim retrospektif olarak incelendi.Çalışma planı: Mayıs 2003 - Temmuz 2005 tarihleri arasında mediastinal kitle tanısıyla 30 hastaya (23 erkek, 7 kadın; yaş ort. 45.3; dağılım 20-65) genel anestezi altında, standart servikal yaklaşımla, aynı cerrahi ekip tarafından mediastinoskopi uygulandı.Bulgular: Histopatolojik incelemede, 14 olguda (%46.6) sarkoidoz, yedi olguda reaktif lenf nodu hiperplazisi (%23.3), beş olguda (%16.8) tüberküloz lenfadenit, dört olguda (%13.3) metastatik lenf nodu (akciğer kanseri-N2) saptandı.Sonuç: Bulgularımız, daha az invaziv yöntemlerle tanısı konulamayan mediastinal lezyonlarda mediastinoskopinin etkili bir yöntem olduğu yönündeki görüşleri desteklemektedir.

Diagnostic mediastinoscopy: analysis of 30 patients

Background: Thirty patients with mediastinal lesions which could not be diagnosed with other diagnostic techniques, have been retrospectively rewieved in order to retrospectively evaluate the results of diagnosis objected mediastinoscopy.Methods: Thirty patients (23 males, 7 females; mean age 45.3 years; range 20 to 65 years) with mediastinal mass underwent diagnostic mediastinoscopy under general anesthesia by the same surgical team by standard cervical approach, between May 2003 and July 2005.Results: According to the histopathological examination, 14 patients (46.6%) had sarcoidosis, 7 patients (23.3%) had reactive lymph node hyperplasia, 5 patients (16.6%) had tuberculotic lymphadenitis, and 4 patients (13.3%) had metastatic lymph node hyperplasia due to lung cancer-N2.Conclusion: Our results support the view that mediastinoscopy is a useful method in patients with mediastinal mass which could not be diagnosed with less invasive diagnostic techniques.

PDF

___

1) Tucker JA. Mediastinoscopy: 300 cases reported and literature reviewed. Laryngoscope 1972;82:2226-48.
2) Kürkçüoğlu C, Eroğlu A, Kaynaş A. Tanısal mediyastinoskopi. University of Ondokuz Mayıs Journal of Medicine 2001; 18:168-171.
3) Jolly PC, Hill LD 3rd, Lawless PA, West TL. Parasternal mediastinotomy and mediastinoscopy. Adjuncts in the diagnosis of chest disease. J Thorac Cardiovasc Surg 1973; 66:549-56.
4) Ponn RB. Invasive diagnostic procedures. In: Shields TW, LoCicero IIIJ, Ponn RB, Rusch VW, editors. General thoracic surgery. Vol. 1. 6th ed. Philedelphia: Lippincott Williams & Wilkins; 2005. p. 299-308.
5) Ginsberg RJ, Rice TW, Goldberg M, Waters PF, Schmocker BJ. Extended cervical mediastinoscopy. A single staging procedure for bronchogenic carcinoma of the left upper lobe. J Thorac Cardiovasc Surg 1987;94:673-8.
6) Hutter J, Junger W, Miller K, Moritz E. Subxiphoidal videomediastinoscopy for diagnostic access to the anterior mediastinum. Ann Thorac Surg 1998;66:1427-8.
7) Davis RD, Oldham HN, Sabiston DC. The mediastinum. In: Sabiston DC, Spencer FC, editors. Surgery of the chest. 5th ed. Philadelphia: W. B Saunders Company; 1990. p. 498-535.
8) Azarow KS, Pearl RH, Zurcher R, Edwards FH, Cohen AJ. Primary mediastinal masses. A comparison of adult and pediatric populations. J Thorac Cardiovasc Surg 1993;106:67-72.
9) Bocage JP, Mackenzie JW, Nosher JL. Invasive diagnostic procedures. In Shields TW, LoCicero J, Ponn RB. General Thoracic Surgery. Vol 1. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 273-48.
10) Toker A, Kalaycı G. Akciğer kanserinde mediastinoskopinin rolü. Toraks Dergisi 2001;2:72-76.
11) Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB. Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. AJR Am J Roentgenol 1985;144:261-5.
12) Specht G. Discussion by carlens. In: Jepsen O, Sorensen HR, editors. Mediastinoscopy. Denmark: Odensa University Press; 1971. p. 130-4.
13) Morrissey B, Adams H, Gibbs AR, Crane MD. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax 1993;48:632-7.
14) Weisbrod GL, Lyons DJ, Tao LC, Chamberlain DW. Percutaneous fine-needle aspiration biopsy of mediastinal lesions. AJR Am J Roentgenol 1984;143:525-9.
15) Vallieres E, Page A, Verdant A. Ambulatory mediastinoscopy and anterior ediastinotomy. Ann Thorac Surg 1991;52:1122-6.
16) Ferguson MK, Lee E, Skinner DB, Little AG. Selective operative approach for diagnosis and treatment of anterior mediastinal masses. Ann Thorac Surg 1987;44:583-6.
17) Kır A, Baysungur SV, Baran R, Akso F, Pandül İ, Atasalihi A. Tanısal mediastinoskopi. Göğüs Kalp Damar Cer Derg 1994;2:347-9.
18) Yüksel M, Akgün S, Pasa S. İntratorasik lezyonların tanısında ve tedavisinin planlanmasında mediyastinoskopinin rolü ve önemi. Solunum Hastalıkları Dergisi 1996;7:21-7.
19) Demircan S, Basoglu A, Celik B, Bilgin S. Mediastinoscopic diagnosis of isolated mediastinal lymph node tuberculosis. Case Rep Clin Pract Rev 2004;5:277-80.
20) Moller DR. Systemic sarcoidosis. In: Fishman AP, editor. Fishman�s pulmonary diseases and disorders. 3rd ed. New York: McGraw-Hill; 1998. p. 1055 68.
21) Truedson H, Stjernberg N, Thunell M. Scalene lymph node biopsy. A diagnostic method in sarcoidosis. Acta Chir Scand 1985;151:121-3.
22) Lincoln JC, Provan JL. Mediastinoscopy in the diagnosis of nonmalignant thoracic disease. J Thorac Cardiovasc Surg 1970;60:144-8.
23) Vansteenkiste JF, Stroobants SG, De Leyn PR, Dupont PJ, Bogaert J, Maes A, et al. Lymph node staging in non-smallcell lung cancer with FDG-PET scan: a prospective study on 690 lymph node stations from 68 patients. J Clin Onco 1998;16:2142-9.
24) Steinert HC, Hauser M, Allemann F, Engel H, Berthold T, von Schulthess GK, et al. Non-small cell lung cancer: nodal staging with FDG PET versus CT with correlative lymph node mapping and sampling. Radiology 1997;202:441-6.