[Examination of the mediastinum in staging of primary bronchial carcinoma].

Mediastinoscopy and CT are used to evaluate the mediastinum in patients with non small cell lung cancer to determine operability. Generally, the sensitivity and negative predictive value of CT are high, in a personal study in 150 patients 86% and 92%, respectively. When CT does not reveal enlarged lymph nodes, we recommend thoracotomy without mediastinoscopy. However, micrometastases in non-enlarged lymph nodes will be missed. All positive CT scans necessitate mediastinoscopy, because enlarged lymph nodes frequently are not invaded with tumour (in our study in 33%). CT used in this way will increase the percentage of positive results of mediastinoscopy. In patients with a peripheral tumour lymphogenic spread to the mediastinum is not uncommon (in our study in 22%) and mediastinal evaluation should not be omitted. In these patients mediastinoscopy is also of diagnostic value.