Diagnostic modalities in the mediastinum and the role of bronchoscopy in mediastinal assessment: a narrative review
Abstract
Background and Objective: Diagnosis of pathology in the mediastinum has proven quite challenging, given the wide variability of both benign and malignant diseases that affect a diverse array of structures. This complexity has led to the development of many different non-invasive and invasive diagnostic modalities. Historically, diagnosis of the mediastinum has relied on different imaging modalities such as chest X-ray, computed tomography (CT), magnetic resonance imaging, and positron emission topography. Once a suspicious lesion was identified with one of these techniques, the gold standard for diagnosis was mediastinoscopy for diagnosis and staging of disease. More recently, many minimally invasive techniques such as CT-guided biopsy, endobronchial ultrasound with transbronchial needle aspiration, and endoscopic ultrasound with fine needle aspiration have revolutionized the diagnosis of the mediastinum. This review provides a comprehensive analysis of all the modalities available for diagnosing mediastinal disease with an emphasis on bronchoscopic techniques. Methods: Literature search was performed via the PubMed database. We included all types of articles and study designs, including original research, meta-analyses, reviews, and abstracts. Key Content and Findings: Minimally invasive techniques such as endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-fine needle aspiration (EUS-FNA) have demonstrated high diagnostic yield…
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