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OBJECTIVE: Surgical biopsy is the best way to biopsy the mediastinal nodes or masses and it provides the greatest chance for adequate diagnosis. The aim of this study was to determine the safety and efficiacy of video assisted thoracoscopic surgery (VATS) in diagnosis of mediastinal diseases of unknown origin.
METHODS: Retrospective chart review of our VATS database between 2005 and 2014 was performed. A total of 24 patients with mediastinal nodes or masses unknown origin, in whom VATS was used as a diagnostic tool were included in the study. The mean age of 15 men and 9 woman was 44,36 + 10.87 (18-61). Fourteen biopsies were performed for a definitive diagnosis of an anterior mediastinal mass and 10 of a mediastinal lymphadenopathy. All cases generally required 2 working ports (5 mm). The tissue samples were obtained with a biopsy forceps, in a fashion similar to the traditional mediastinoscopic procedures. A right sided approach was used in 14 and left sided in 10 of the patients.
RESULTS: In all instances, enough material for pathologic analysis was taken, showing sarcoidosis in 5 patients, lymphoma in 9 patients, metastasis of an extrathoracic malignancy in 8 patients, metastasis of a small cell lung carcinoma in one patient and a reactive lymph node in one patient. No conversion to open thoracotomy was needed. Neither morbidity nor mortality was observed. The median hospital stay was 1 day after surgery.
CONCLUSIONS: VATS is a safe and accurate minimally invasive approach for sampling of mediastinal masses and lymph nodes. The diagnostic efficacy of VATS was 100% in our series. While clinical judgement in combination with radiographic imaging can often narrow the diagnostic possibilities in mediastinal diseases, definitive pathological diagnosis is required prior to initiating therapy. VATS allows excellent exposure of all compartments of the mediastinum and the lymph nodes or masses can be either sampled or totally removed with VATS. This is important, because specimens of significant size are requested, as for the pathological diagnosis of some diseases such as lymphomas.