Which diagnostic procedures are performed in the evaluation of superior vena cava syndrome (SVCS)?

Updated: Mar 26, 2018
  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Most patients with SVCS present before the primary diagnosis is established. Controversy often arises in the treatment of these patients with regard to the need for pathologic confirmation of malignancy before the start of therapy. Treatment without an established diagnosis should be initiated only in patients with rapidly progressive symptoms or those in whom multiple attempts to obtain a tissue diagnosis have been unsuccessful.

Fortunately, relatively noninvasive measures establish the diagnosis in a high percentage of patients with SVCS. Sputum cytologic results are diagnostic in 68% of the cases, whereas biopsy of a palpable supraclavicular node is positive in 87%. [22] Bronchoscopy has a 60% success rate, whereas thoracotomy is 100% successful. [22] Open biopsy is rarely needed for diagnosis. Dosios et al showed that cervical mediastinoscopy and anterior mediastinoscopy are effective in establishing a histologic diagnosis. [23]


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