Percutaneous Needle Aspiration for Benign Mediastinal Masses

Abstract

Percutaneous needle aspiration (PCNA) of mediastinal masses is an effective modality for the diagnosis of malignancies, especially for staging of lung cancer. Its usefulness in diagnosing benign condition has been poorly documented. This study reports the results of 65 patients with benign mediastinal masses who were subjected to PCNA after prior work-up (including bronchial needle aspiration or mediastinoscopy in most cases) was nondiagnostic. The lesions measured from 2.3 to 10.5 cm in the largest diameter, with a mean of 4.6 cm. The following lesions were present: thymoma, 3; lipoma, 6; cyst, 12; tuberculosis, 14; nonspecific inflammation, 7; sarcoid, 4; thyroid, 5; abscess, 3; neurinoma, 3; rheumatoid inflammation, 1; aortic aneurysm, 2; Castleman's tumor, 1; osteochondroma, 1; and 3 remained undiagnosed. The patients were 13 to 75 years of age, with a mean age of 44.8 years. Forty-four were female, and 21 were male. Most patients were asymptomatic (40) or with unspecific symptoms, such as malaise (18), substernal pain (16), low-grade fever (12), and cough (10). There were no false-positive aspirates for malignancy. In four patients, the cytologic diagnosis was false-negative. PCNA resulted in introduction of chemotherapy in 11 of 14 patients with tuberculosis. Six of 12 cysts disappeared after PCNA. Contemplated surgery was abandoned in 4 of 6 patients with fatty mass and in 3 of 5 patients with mediastinal thyroid. A small pneumothorax occurred in 7 patients. PCNA is of value in the diagnosis of benign mediastinal masses. The cytologic diagnosis is reliable. PCNA may obviate the need for invasive diagnostic procedures and may lead to adequate treatment of tuberculosis.