Biopsy by a cut on the neck

What is a cervical mediastinoscopy?

Getting a biopsy of glands by through a  cut on the neck is called a cervical mediastinoscopy. This is an operation used to get biopsies of the lymph glands in the upper part of the chest (mediastinum), behind the breastbone.

Why do I need a cervical mediastinoscopy?
1. Staging for lung cancer to see how far it has spread may need cervical mediastinoscopy, particularly if other methods could not be sure of the stage.

2. Diagnosing the cause of a lump in the chest which was seen on scans.

In both cases the results guide the best course of treatment.

What does the surgery involve?
You will be fully asleep under a general anaesthetic, the surgery takes about 45 minutes. A horizontal incision, about 2 to 3cm long, is made in the lower part of the neck. The surgeon tries to hide the incision in a skin crease if one is there. A camera is passed next to the windpipe behind the breastbone through the incision to get into the upper part of the chest. Biopsies of lymph glands next to the windpipe can then be taken. The incision is closed with dissolvable stitches.

It can take 2 weeks for the laboratory to give results. Results for infections such as TB may take 12 weeks. If we receive results before you are due to come to a clinic appointment we may call you.

What is recovery like?

You can normally go home on the same day as surgery. This depends on your recovery,  so bring an overnight bag just in case.

You will need a responsible adult to be with you for the first 24 hours after surgery. You should not drive for 48 hours and you should not go back to work before 72 hours. Drink plenty of fluids and rest when you go home.

The lower part of your neck and your throat will be sore but taking paracetamol as needed should keep you comfortable.

If you need to have a chest drain or have problems with bleeding you will need to stay in hospital longer.

What are the risks?

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your consultant, especially if you are concerned.

  • Minor and more common complications

Wound infection. If your wound becomes more sore, red or leaks fluid there may be a wound infection. This is usually treated with antibiotics and dressings.

Bleeding. Bleeding is usually minimal but you should expected some bruising and swelling on the neck.

  • Major and more rare complications

Collapsed lung. The top of the lung is close to where biopsies need to be taken. Air may get into the pleural space and cause a collapsed lung. This may settle with observation or require a chest drain to be inserted to remove the air. If you have chest pain or feel short of breath after your procedure tell your nurse.

Hoarse voice. The nerves that supply the voice box run close to the windpipe. They may become stretched or damaged during the operation. This would result in a hoarse voice which is usually temporary but rarely may be permanent.

Injury to large blood vessels that are behind the breastbone. There is a very very small risk of major bleeding ( 1 in 500 cases) if one of these vessels is damaged. If there is severe bleeding you may need a blood transfusion. Bleeding can usually be controlled and the vessel repaired. To do this an additional incision would need to be made called a median sternotomy. This is a vertical incision, approximately 20cm long, in the centre of the chest which goes through the breastbone. It is needed to get  into the chest to control severe bleeding.

Death is possible but very rare, it is usually happens if a person has a medical condition that leads to a complication.

Blood clots. This is general risk with any operation that involves staying in hospital.

What are the alternatives to surgery?
Having a diagnosis can guide the best treatment for you. It can also give you an idea of what to expect from the disease, including symptoms to expect or whether the condition may shorten your life. Staging is very important in deciding which treatment to give for lung cancer. At advanced stages of cancer surgery to remove part of the lung would not give you any benefit.

If you do not want to have an operation to get a diagnosis other options may include:

  • Biopsies of the lymph glands can be taken using ultrasound during bronchoscopy (EBUS). This is usually tried first but samples may be too small or difficult to access to get a diagnosis.
  • Relying on existing tests (such as CT scans) to judge which disease is most likely
  • Repeating a previous test.

It is your choice whether to go ahead with surgery. We will respect your wishes and support you in choosing the treatment that suits you best. You are always welcome to seek a second opinion.