Optimization of Lung and Mediastinal Tumor Diagnosis Using Fluoroscopic-Guided Transthoracic Puncture-Biopsy

Abstract

"Introduction: Pathological confirmation of a newly identified tumor is mandatory to create an adequate treatment plan. Patients may have multiple health comorbidities, making them unsuitable for traditional invasive diagnostic procedures. The percutaneous transthoracic biopsy is a minimally invasive alternative method that can provide tissue samples to identify, diagnose, and classify lung or mediastinal tumors. Materials and methods: Data from patients who underwent fluoroscopic-guided transthoracic needle biopsy (FGTNB) in a tertiary cancer center in the Republic of Moldova from 2019 to 2021 were collected retrospectively. Results: We identified 54 patients with lung and 12 with mediastinal tumors. In the lung tumor group, the median age was 57 years; in the mediastinal tumor group, the median was 27.5 years. Most lung tumors were situated in the superior lobes (79.6%) and were found to be less than 5 cm in diameter (70.4%). Most mediastinal tumors were anteriorly located (66.7%) and were found to be more than 10 cm in diameter (58.3%). The sensitivity of transthoracic percutaneous biopsy was 79.6% in lung tumors and 83.3% in mediastinal tumors. The patients we biopsied were identified with either malignancy, infectious pathology, or pulmonary fibrosis. Transthoracic needle biopsy of the lung showed a low rate of pneumothorax (5.6%) and a low rate of bleeding (3.7%). Mediastinal tumor biopsy had a rate of pneumothorax of 16.7%, significantly higher than lung biopsy. Conclusion: Transthoracic needle biopsy performed under fluoroscopic guidance is a safe and efficient alternative diagnostic procedure for comorbid patients with lung or mediastinal tumors."