Diagnosis of mediastinal lymphadenopathy: Clinical-radiological methods vs. mediastinoscopy

Introduction: Today, mediastinal lymphadenopathy (MLAP) is increasingly detected and diagnosed owing to major technological advances. Nevertheless, efficacy of clinical-radiological methods has not yet been evaluated properly in comparison with cervical mediastinoscopy, considered the gold standard method for diagnosis of MLAP. Objectives: To evaluate diagnostic abilities of modern clinical –radiological methods in comparison with mediastinoscopy in patients with MLAP. Methods: A retrospective review of 103 patients9 medical documents with MLAP admitted to Western Galilee Hospital from 2001-2012. Of 103 patients 59 male, 44 female; mean age 57 years. Clinical-radiological methods together with mediastinoscopy were employed for diagnosis. Ancillary methods (bronchoscopy with needle biopsy, skin and bone marrow biopsy, etc) were used in 33.3% of MLAP patients. Preliminary clinical-radiological diagnosis of MLAP type was compared with results of mediastinoscopy. Results: Preliminary clinical-radiological diagnosis of MLAP type was confirmed by mediastinoscopy in patients with: sarcoidosis -83.9%, bronchogenic carcinoma -82.4%, lymphoma -33.7%, non-specific lymphadenopathy-20.4%. Prompt employment of mediastinoscopy helped establish diagnosis during one-two weeks (51.4%). Mediastinoscopy was performed without complications with diagnostic yield 100%. During patient follow up there were no changes in established diagnosis. Conclusions: Clinical-radiological preliminary diagnosis was very effective in patients with sarcoidosis and bronchogenic carcinoma. Lymphoma (early stage) and non-specific enlargement of mediastinal lymph nodes were rather difficult to diagnose without mediastinoscopy.