An evaluation of mediastinoscopy as a guide to diagnosis and therapy.

A retrospective study was made of 230 consecutive unselected mediastinoscopies done during the years 1969 through 1975 in an attempt to identify guidelines for selective use of mediastinoscopy. Findings at mediastinoscopy were correlated with pathologic diagnosis, location and size of the lesion, presence or absence of enlarged lymph nodes on chest x-ray film, and findings at subsequent thoractomy when performed. On the basis of this review, the following lesions seem amenable to diagnosis at mediastinoscopy: bilateral hilar adenopathy (24 of 25 in this study); central lesions (30 of 45); peripheral lesions with adenopathy seen on x-ray film (nine of 22); and infiltrates (eight of 24). Mediastinoscopy is not recommended for peripheral lesions without adenopathy seen on x-ray film.