Lymph Nodes

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Physical examination can sometimes detect metastasis to cervical lymph nodes (in the neck). In the past, a surgical biopsy called a scalene node biopsy was often done. It is seldom indicated at this time.

Markedly enlarged mediastinal nodes can be seen on chest x-ray. Computerized tomograms are much better and can detect lymph nodes as small as one centimeter in size. The CT scan cannot tell for sure if an enlarged node is caused by cancer or by another cause. If it is clinically important to know whether enlarged lymph nodes contain cancer, they can be biopsied via a needle biopsy in the neck or by mediastinoscopy in the case of enlarged mediastinal nodes. Mediastinoscopy is done through a small incision at the base of the neck just above the breast bone. Under general anesthesia, a mediastinoscope is passed through a short incision down into the chest, lymph nodes are identified and biopsied. Lymph node metastasis to mediastinal nodes in the left chest cannot be reached by the mediastinoscope, and are biopsied by anterior mediastinotomy, an operation done under general anesthesia in which an upper left costal cartilage (the part of the rib immediately lateral to the breast bone) is removed through a short insicion, and lymph nodes are biopsied.

Some surgeons are doing mediastinal sampling using video assisted techniques. There is minimal information on this approach.

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