THE ROLE OF PARASTERNAL MEDIASTINOTOMY IN THE DIAGNOSIS OF MEDIASTINAL TUMORS

Parasternal mediastinotomy is a surgical method of morphological verification of mediastinal tumors, widely performed in oncological clinics. The article provides information about the method of implementation and the results of parasternal mediastinotomy for malignant tumors of the mediastinum.

Purpose of the study. Evaluation of the results of parasternal mediastinotomy for morphological verification of mediastinal tumors.

Patients and methods. The study included 77 patients who for the period from 2008 to 2018. 80 parasternal mediastinotomies were performed with a biopsy of a mediastinal tumor in the conditions of the Department of Thoracic Surgery of the P. Hertsen Moscow Oncology Research Institute. At the stage of preoperative examination, all patients underwent standard diagnostic studies: computed tomography of the chest, abdominal cavity, and a comprehensive ultrasound. In the case of the presence of the endobronchial component of the tumor, fibrobronchoscopy was performed. MRI of the brain was performed in patients with neurological symptoms. 12-lead ECG, echocardiography, and a study of the function of external respiration were performed to assess the functional status of patients.

Results. The final histological diagnosis was made in 76 of 77 (99%) patients. The clinical diagnosis of lymphoma was set in 66, thymoma — in 6 patients, lung cancer with affection of mediastinal lymph nodes — in 4 patients, mediastinal tumor — in 4 patients. In 24 patients (31%), operations were preceded by other attempts at morphological verification. In 12 patients — mediastinal tumor biopsy under ultrasound control, in 3 — parasternal mediastinotomy, in 2 — transthoracic mediastinal tumor biopsy combined with biopsy of supraclavicular lymph node under ultrasound control, 2 — biopsy of supraclavicular lymph node under ultrasound control, in 1 — mediastinum tumor biopsy under control. — chest wall biopsy, in 1 — open biopsy with thoracotomic access, in 1 — tonsil biopsy, in 1 — trachea biopsy. In all cases, the indication for performing a parasternal mediastinotomy was an insufficient amount of material for carrying out a complete immunohistochemical study.

Conclusion. Parasternal mediastinotomy is a safe and reliable method of morphological verification of the formations of the anterior mediastinum and para-aortic region. In case of the ineffectiveness of transthoracic biopsy under the control of ultrasound or CT navigation, the performing of parasternal mediastinotomy allows to establish a morphological diagnosis and to begin a specific treatment in the shortest possible time.

1. McNeill TM, Chamberlain JM. Diagnostic anterior mediastinotomy. Ann Thorac Surg. 1966 Jul;2 (4):532–9.

2. Jiao X, Magistrelli P, Goldstraw P. The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe. Eur J Cardiothorac Surg. 1997 Mar;11 (3):450–4.

3. Merrick AF, Odom NJ. Prevention of a phrenic nerve palsy following left anterior mediastinotomy. Eur J Cardiothorac Surg. 1994;8 (3):153–4.

4. Venuta F, Rendina EA. Superior vena cava resection and reconstruction. Eur J Cardiothorac Surg. 2012 May;41 (5):1177–8. DOI: 10.1093/ejcts/ezr266.

5. Dosios T, Theakos N, Chatziantoniou C. Cervical mediastinoscopy and anterior mediastinotomy in superior vena cava obstruction. Chest. 2005 Sep;128 (3):1551–6. DOI: 10.1378/chest.128.3.1551

6. Zafar N, Moinuddin S. Mediastinal needle biopsy. A 15-year experience with 139 cases. Cancer. 1995 Sep 15;76 (6):1065–8.

7. Morrissey B, Adams H, Gibbs AR, Crane MD. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax. 1993 Jun;48 (6):632–7.

8. Kazakevich VI. Possibilities of percutaneous ultrasound study in determining the intrathoracic extent of the process in lung cancer and mediastinal tumors. Onkologiya. Zhurnal imeni P. A. Gerzena (P. A. Herzen Journal of Oncology). 2013; 1 (5): 10–18. (In Russian).

9. Jahangiri M, Goldstraw P. The role of mediastinoscopy in superior vena caval obstruction. Ann Thorac Surg. 1995 Feb;59 (2):453–5.

10. Elia S, Cecere C, Giampaglia F, Ferrante G. Mediastinoscopy vs. anterior mediastinotomy in the diagnosis of mediastinal lymphoma: a randomized trial. Eur J Cardiothorac Surg. 1992;6 (7):361–5.

11. Kheir F, Itani A, Assasa O, Alraiyes AH. The utility of endobronchial ultrasound-transbronchial needle aspiration in lymphoma. Endosc Ultrasound. 2016 Jan-Feb;5 (1):43–8. DOI: 10.4103/2303– 9027.175884.

12. Aabakken L, Silvestri GA, Hawes R, Reed CE, Marsi V, Hoffman B. Cost-efficacy of endoscopic ultrasonography with fine-needle aspiration vs. mediastinotomy in patients with lung cancer and suspected mediastinal adenopathy. Endoscopy. 1999 Nov;31 (9):707–11. DOI: 10.1055/s-1999–74

13. Kennedy MP, Jimenez CA, Bruzzi JF, Mhatre AD, Lei X, Giles FJ, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax. 2008 Apr;63 (4):360–5. DOI: 10.1136/thx.2007.084079

14. Erer OF, Erol S, Anar C, Aydoğdu Z, Özkan SA. Diagnostic yield of EBUS-TBNA for lymphoma and review of the literature. Endosc Ultrasound. 2017 Sep-Oct;6 (5):317–322. DOI: 10.4103/2303– 9027.180762

15. Karthik S, Milton R, Papagiannopoulos K. Simultaneous double video mediastinoscopy and video mediastinotomy — A step forward. Eur J Cardiothorac Surg. 2005 May;27 (5):920–2. DOI: 10.1016/j.ejcts.2005.01.052