Mediastinoscopy is the ‘gold standard’ method for determining the presence of nodal metastases in the mediastinum. Generally performed as an outpatient surgical procedure, it is associated with a low rate of serious adverse effects (<1%) and the procedure is highly accurate, with false negative rates reported to be between 6% and 9%. Endobronchial ultrasound (EBUS) guided fine needle aspiration biopsy of mediastinal nodes offers a less invasive alternative for histologic sampling of the mediastinal nodes. The procedure has been widely adopted by pulmonologists and is poised to replace mediastinoscopy in the future. For thoracic surgeons, the technique can be easily learned and it may be important to do so if our specialty is to maintain its traditional and important role in the diagnosis and staging of thoracic malignancies.
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