Ultrasound-guided needle aspiration biopsy of anterior mediastinal masses in the hands of pulmonologists

Abstract

<b>Introduction:</b> Transthoracic ultrasound is increasingly used in the setting of pulmonary medicine for visualizing pleural effusions, as well as for assisting thoracentesis, chest tube placement, and biopsy of lung or thoracic wall lesions. However, anterior mediastinal masses have been traditionally sampled by radiologists of thoracic surgeons, often under CT-guidance. <b>Aim:</b> To assess the feasibility, diagnostic success and safety of ultrasound-guided needle aspiration biopsy (US-NAB) of anterior mediastinal masses in the hands of pulmonologists. <b>Methods:</b> We reviewed the US-NABs performed consecutively for the diagnosis of anterior mediastinal masses during a 2-year period (2020-2021) in 2 Italian centers (Policlinico Gemelli, Rome and Spedali Civili, Brescia). All the procedures were performed by pulmonologists with either 16G or 18G needles using the “free hand” technique and a parasternal approach. <b>Results:</b> During the study period, 20 patients were evaluated and 18 underwent a US-NAB (90% feasibility); in the remaining two cases the biopsy was not attempted because of the lack of a safe ultrasound window. US-NAB allowed to achieve a definitive diagnosis (lymphoma, 13 patients; germ cell tumor, 2; thymoma and pulmonary adenocarcinoma, 1) in 17 of the18 patients in whom it was attempted (94% diagnostic yield). In the patient in whom the US-NAB was inconclusive, a diagnosis of undifferentiated epithelial malignancy was obtained on a massively necrotic sample obtained with a surgical lung biopsy. No complications were observed. <b>Conclusions:</b> Properly trained pulmonologists can perform US-NAB of anterior mediastinal masses safely and with an excellent diagnostic success.