Abstract
Ultrasound-guided transthoracic core needle biopsy (US-TCNB) is a promising method for establishing the correct diagnosis of mediastinal masses. However, the existing studies in this area are scant and with small samples. To evaluate the diagnostic value and the complication rate of US-TCNB, particularly large bore cutting biopsy in patients with mediastinal lesions. This retrospective study includes 566 patients with mediastinal lesions suspicious of malignancy evaluated between March 2004 and December 2018. Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2. Lesions more than 15 mm; 3. Negative histological diagnosis after bronchoscopic biopsy; 4. Normal coagulation status; 5. Cooperative patient; 6. Written informed consent. US visualization of the mediastinal lesions was successful in 308 (54.4%). In all of them, US-TCNB was performed. All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%). All patients inappropriate for image-guided TTNB were referred to primary surgical diagnostic procedures (n = 217, 38.3%). The US-TCNB is a highly effective (accuracy 96%, sensitivity 95%) and safe tool (2.6% complications) in the diagnosis of all subgroups mediastinal lesions. It is non-inferior to CT-TTNB (90%) and comes close to the effectiveness of surgical biopsy techniques (98.4%), but is less invasive and with a lower complication rate. US-TCNB of mediastinal lesions is highly effective and safe tool which is particularly helpful in critically ill patients.
Highlights
The morbidity of mediastinal tumors increases in the last 15 years and in 2014 it is 0.5/100,000 in men and 0.4/100,000 in women [1]
Inclusion criteria: 1. Patients with mediastinal lesions detected on thoracic CT scan; 2
All patients with mediastinal lesions unsuitable for US visualization were evaluated for a CT-guided transthoracic needle biopsy (CT-TTNB), which was done if the presence of a safe trajectory was available (n = 41, 7.2%)
Summary
The morbidity of mediastinal tumors increases in the last 15 years and in 2014 it is 0.5/100,000 in men and 0.4/100,000 in women [1]. The main imaging modalities used in the evaluation of mediastinal abnormalities (chest X-ray, CT, MRI, and PET) have high sensitivity in the detection of mediastinal lesions and could give valuable information about the size, location and metabolic activity [2]. Imaging and clinical evaluation often do not allow a conclusion regarding the final diagnosis in these patients. Percutaneous needle biopsy of mediastinal lesions under fluoroscopic guidance was first described in 1967 [3]. Since 1980 computed tomography had almost replaced fluoroscopy as a guide for a transthoracic needle biopsy (TTNB) [3]. CT guidance has the advantage of accurate localization of the lesion and reducing the risk of puncturing vessels in the mediastinum [4]
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