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February 1967

Significance of Mediastinoscopy in Carcinoma of the Lung

Author Affiliations

Iowa City
From the Department of Otolaryngology (Dr. Flynn), Division of Thoracic Surgery (Dr. Rossi), and the Department of General Surgery (Dr. Lawton), University Hospitals and Veterans Administration Hospital, Iowa City.

Arch Surg. 1967;94(2):243-246. doi:10.1001/archsurg.1967.01330080081021

EXPLORATION of the mediastinum for the purpose of obtaining the diagnosis of intrathoracic pathology was stimulated by Daniels1 in 1949 when he reported the first series of supraclavicular node biopsies. The quest for diagnoses was pursued further by Harkins and associates2 when they proposed exploring behind the clavicle with a laryngoscope at the time of scalene node biopsy. In 1959 Carlens3 was able to report 100 cases in which he had biopsied hilar and subcarinal lymph nodes from a supraclavicular incision during a procedure he called mediastinoscopy. These steps in the development of mediastinoscopy have a definite anatomic basis in the work done by Rouviere4 and confirmed by Palva,5 when they demonstrated that the lung lymphatics drained to subcarinal and paratracheal areas and then up along the sides of the trachea of the supraclavicular areas. Each advance in the evolution of mediastinoscopy has brought the

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