Videomediastinoskopie v diagnostice a stagingu onemocneni mediastina.

In the first part of the article the overview of all available techniques and indications for mediastinoscopy, with its tradition of 42 years, especially in Europe and the United States, is presented. Current tendencies in staging and therapy of lung cancer, but also in other malignancies, favor mediastinoscopic examination in case of an advanced malignant diesease is suspected. Videotechnique brings new concepts and possibilities to the use of the "old fashioned" method. Techniques and advantages of the videomediastinoscopy in comparison with classical cervical mediastinoscopy are given. The second part is dedicated to the analysis of the group of 71 patients, operated between 1997 - 2000 in the 1st Department of Surgery, St. Anna University Hospital, Brno. There were 47 men and 24 women (mean age 48,06 years) operated by videomediastinoscopy. Clearly defined pathology was found in 57 cases (80,28%), in 14 cases (19,72%) the result was negative. By edditional surgical procedure (thoracoscopy, thoracotomy, anterior mediastinotomy) 6 cases of the false negativity (8,45%) and 3 cases of the true negativity were disclosed. There were 3 patients with superior vena cava syndrome (2 cases of lymphoma and one case of thymic carcinoma). The most frequent pathologically confirmed diagnosis was lung cancer dissemination (18 cases), followed by Hodgkin's disease (11 patients). Sarkoidosis was the most common benign diagnosis (16 cases). The results in terms of sensitivity, specificity, diagnostic accuracy, positive and negative predictive value were 0,90 - 0,89 - 0,90 - 0,98 and 0,57 respectively. We had one surgical (1,41%) and one non-surgical (1,41%) complications. We had no mortality. In the third part of the article the current position of the videomediastionoscopy in the spectrum of other invasive and non-invasive techniques in the diagnosis and therapy of the mediastinal diseases is analyzed. The lack of accuracy of the non-invasive detection of the malignant disease in the mediastinum in our conditions is described. In conclusion, we believe, that videomediastinoscopy is highly safe, up-to date procedure, and it is the method of choise especially in lung cancer staging. Even in the presence of the advances of the non-invasive techniques due to positron emission tomography (PET), histological confirmation of the mediastinal disease remains essential for the diagnostic and therapeutic work-up. The wider use of the technique in the Czech Republic is recommended.Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi