During the test, a doctor makes a small cut (incision) in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then the doctor places a thin scope in the opening. A tissue sample (biopsy) can be collected through the scope and then looked at under a microscope for lung problems. These problems might include infection, inflammation, or cancer.
In many cases, this surgery has been replaced by other biopsy methods that use computed tomography (CT), echocardiography, or bronchoscopy to guide a biopsy needle. This test may still be needed when the other methods can't be used or when they don't show clear results.
Why It Is Done
This test is done to:
- Look for problems of the lungs and mediastinum, such as sarcoidosis.
- Diagnose lung cancer or lymphoma (including Hodgkin's disease). It is often done to check lymph nodes to see if you should have lung removal surgery to treat lung cancer. The test can also help your doctor recommend the best treatment for lung cancer. Treatment may include surgery, radiation, or chemotherapy.
- Diagnose certain types of infection, such as tuberculosis.
How To Prepare
You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.
Talk to your doctor if you have any concerns about the need for the test, its risks, how it will be done, or what the results will mean. Be sure to ask what may be done after each possible biopsy result. If a lymph node contains cancer, surgery may be done to remove the cancer while you are still asleep. To help you understand the importance of this procedure, fill out the medical test information form(What is a PDF document?).
Before you have this test, tell your doctor if you:
Also, certain conditions may make it harder to do this test. Let your doctor know if you have:
- Had this test or open-heart surgery in the past. The scarring from the first procedure may make it hard to do a second one.
- A history of neck problems or a neck injury, especially anything that may have caused your neck muscles to stretch too much, like whiplash.
- Any problems in your chest, including those you've had since birth.
- Had radiation treatment to the neck or chest.
You will get general anesthesia and be asleep during the test. To prepare for this test:
- Your doctor will tell you how soon to stop eating and drinking before the test. The surgery may be canceled if you don't follow these instructions. If your doctor has told you to take your medicines on the day of surgery, take them with only a sip of water.
- Leave your jewelry at home. Any jewelry you wear will need to be removed before the test.
- Remove glasses, contact lenses, and dentures or a removable bridge just before the test. These will be given back to you as soon as you wake up after the test.
- Arrange to have someone drive you home if you don't need to stay in the hospital.
How It Is Done
Before the surgery, an intravenous (IV) line will be placed in a vein to give you fluids and medicines. After you are asleep, a tube will be placed in your throat to help you breathe.
The doctor will make an incision just above your breastbone at the base of your neck or on the left side of your chest near the breastbone. The scope will be inserted through the opening. Your doctor will look at the space in your chest between your lungs and heart. Lymph nodes or abnormal tissue will be collected for testing. After the scope is taken out, the incision will be closed with a few stitches and covered with a bandage.
The entire procedure usually takes about an hour. After the test, you will be taken to the recovery room.
Some people may go home if they can swallow fluids without gagging or choking. Others may need to stay in the hospital for 1 or 2 days.
If your stitches are not the dissolving type, you will need to go back to the doctor in 10 to 14 days to have them removed. Mediastinoscopy usually leaves only a tiny scar.
How It Feels
Before the test, you may be given medicine to relax you. You will then get general anesthesia, which will make you sleep. After you wake up, you may feel sleepy for several hours. You may feel tired for a day or two and have some general aches and pains.
You may also have a mild sore throat from the tube that was in your throat. Using throat lozenges and gargling with warm salt water may help.
Problems from mediastinoscopy are uncommon but may include bleeding, infection, a collapsed lung, a tear in the esophagus , damage to a blood vessel, or injury to a nerve near the voice box (larynx) which may cause permanent hoarseness.
After the test, contact your doctor right away if you have:
- Bleeding from your stitches.
- A fever.
- Severe chest pain.
- Swelling in the neck.
- Shortness of breath.
- Trouble swallowing.
- Hoarseness of your voice that lasts more than a few days or keeps getting worse.
Mediastinoscopy is surgery to look at the inside of the upper chest between and in front of the lungs. This area is called the mediastinum.
Lymph nodes are small, smooth, and appear normal.
There are no abnormal tissue, growths, or signs of infection.
Lymph nodes may be enlarged or appear abnormal. This may mean sarcoidosis, infection, or cancer. Tissue samples are removed and examined under the microscope.
Abnormal growths (such as a tumor) or signs of infection (such as an abscess) may be found in the chest cavity, or mediastinum.
What Affects the Test
If you have had mediastinoscopy or open-heart surgery, you may not be able to have this test. Scarring from the first procedure may make it hard to do this test.
What To Think About
If a lymph node biopsy needs to be examined quickly (while you are still asleep), the sample will be taken to the lab right away. If the lymph nodes show that you have cancer, surgery may be done to remove the cancer while you are still asleep. If the results are not needed quickly, they will usually be ready in 2 to 4 working days.
Other Works Consulted
Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
Pagana KD, Pagana TJ (2014). Mosby's Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerRobert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
Current as ofAugust 21, 2015