ABSTRACT
To assess the feasibility and accuracy of mediastinal lymph node biopsy via mediastinotomy incision and compare its accuracy with scalene lymph node biopsy in cases of mediastinal lymphomas with no palpable relevant lymph nodes. We received 20 patients with a picture suggestive of mediastinal lymphomas during the period between March, 2003 and April, 2006 at the Department of Cardiothoracic Surgery-Suez Canal University Hospitals. We received 9 male patients [45%] and 11 females [55%]. The age ranged between 18 and 56 years with average age of 31+2.1 years. Eight patients [group A] had been operated upon via mediastinotomy incisions alone to shorten the time of anaesthesia. In the other group B, 12 patients had both mediastinotomy incisions and scalene lymph node biopsies as the general condition was good in all patients. The results in both groups were compared. In group A, all the 8 patients were histopathologically diagnosed after mediastinal lymph node biopsies. The material of the biopsy was enough to help the pathologist to give the accurate diagnosis. Five patients had local intercostal nerve block and sedation but the other three tolerated short term general anaesthesia no single mortality but only one had severe chest infection which was treated successfully. In group B: All patients had biopsies of both mediastinal lymph nodes and scalene lymph nodes under general anaesthesia. No mortalities but there were excessive bleeding and wound infection-related to scalene biopsy in one patient. All samples taken from mediastinal lymph nodes were diagnostic. Scalene lymph node biopsies: Only in four cases we get the same histopathological report for the scalene LN biopsy as that of mediastinal L.N. These four patients had splenomegaly and enlarged abdominal para-aortic LN thus, we selected left-sided scalene LN biopsy. The remaining 8 reports of scalene biopsies were non-specific and non-diagnostic. Mediastinal lymph node biopsy via a mediastinotomy incision in the 2[nd] or 3[rd] left intercostal space is a safe and accurate approach to diagnose cases of mediastinal lymphadenopathy. Scalene lymph node biopsy is less specific and gives a lower diagnostic yield [40% Vs 100%]. Evaluation of sensitivity of left-sided scalene LN biopsy in cases with enlarged abdominal LN needs further studies