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Diagnostic-Procedures

Mediastinoscopy

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 21, 2021.

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.

Why is it performed?

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
  • Thymomas (thymus gland tumors)
  • Cysts
  • Aneurysms
  • Other blood vessel abnormalities

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

How to prepare for a mediastinoscopy

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.

What to expect during 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.

After the procedure

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.

What are the risks?

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.