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. 1992 May;47(5):377–380. doi: 10.1136/thx.47.5.377

Mediastinal malignancy: ultrasound guided biopsy through the supraclavicular approach.

P C Yang 1, D B Chang 1, Y C Lee 1, C J Yu 1, S H Kuo 1, K T Luh 1
PMCID: PMC463758  PMID: 1609382

Abstract

BACKGROUND: Malignancies located in the upper middle mediastinum usually do not have a sufficiently large acoustic window to permit a conventional ultrasound guided parasternal biopsy. This study was concerned with an alternative approach whereby ultrasound is applied through the supraclavicular paratracheal window to allow percutaneous biopsy of middle mediastinal malignancies. METHODS: Fifteen patients who had upper mediastinal malignancies not in contact with the chest wall underwent real time and Doppler ultrasonographic studies by the supraclavicular approach. None of these tumours could be reached by conventional ultrasound guided parasternal biopsy. The ultrasound was scanned downwards through the supraclavicular fossa, along the acoustic window of the paratracheal soft tissue space. Percutaneous aspiration biopsy was performed with a 22 gauge needle under ultrasound guidance. If fine needle aspiration could not obtain an adequate tissue smear an 18 gauge Trucut biopsy was performed to obtain a histological diagnosis. RESULTS: Twelve of 15 mediastinal malignancies were detected by ultrasound through the supraclavicular approach. These 12 patients underwent percutaneous needle aspiration biopsy under ultrasound guidance. Four of the patients also had a Trucut biopsy because the needle aspirates from the tumours were inadequate. The needle had to pass through the jugular veins in four patients who received fine needle aspiration but in none of the patients who required a Trucut biopsy. Definite histological diagnoses were obtained in all 12 of these patients. Ten of the tumours were malignant and two benign. None of the patients developed any complication. CONCLUSIONS: Ultrasound and ultrasound guided biopsy through the supraclavicular paratracheal window provides a new approach for malignancy located in the upper middle mediastinum, which cannot be reached by conventional ultrasound guided parasternal biopsy. The diagnostic yield of this technique is high and the procedure is relatively safe.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adler O. B., Rosenberger A., Peleg H. Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences. AJR Am J Roentgenol. 1983 May;140(5):893–896. doi: 10.2214/ajr.140.5.893. [DOI] [PubMed] [Google Scholar]
  2. Chen C. R., Lee L. N., Kuo S. H., Luh K. T. Ultrasonically guided percutaneous mediastinal cytology and biopsy. Taiwan Yi Xue Hui Za Zhi. 1986 Jun;85(6):561–566. [PubMed] [Google Scholar]
  3. Ikezoe J., Sone S., Higashihara T., Morimoto S., Arisawa J., Kuriyama K. Sonographically guided needle biopsy for diagnosis of thoracic lesions. AJR Am J Roentgenol. 1984 Aug;143(2):229–234. doi: 10.2214/ajr.143.2.229. [DOI] [PubMed] [Google Scholar]
  4. Pedersen O. M., Aasen T. B., Gulsvik A. Fine needle aspiration biopsy of mediastinal and peripheral pulmonary masses guided by real-time sonography. Chest. 1986 Apr;89(4):504–508. doi: 10.1378/chest.89.4.504. [DOI] [PubMed] [Google Scholar]
  5. Saito T., Kobayashi H., Sugama Y., Tamaki S., Kawai T., Kitamura S. Ultrasonically guided needle biopsy in the diagnosis of mediastinal masses. Am Rev Respir Dis. 1988 Sep;138(3):679–684. doi: 10.1164/ajrccm/138.3.679. [DOI] [PubMed] [Google Scholar]
  6. Todd T. R., Weisbrod G., Tao L. C., Sanders D. E., Delarue N. C., Chamberlain D. W., Ilves R., Pearson F. G., Cass W., Cooper J. D. Aspiration needle biopsy of thoracic lesions. Ann Thorac Surg. 1981 Aug;32(2):154–161. doi: 10.1016/s0003-4975(10)61023-5. [DOI] [PubMed] [Google Scholar]
  7. Weisbrod G. L., Lyons D. J., Tao L. C., Chamberlain D. W. Percutaneous fine-needle aspiration biopsy of mediastinal lesions. AJR Am J Roentgenol. 1984 Sep;143(3):525–529. doi: 10.2214/ajr.143.3.525. [DOI] [PubMed] [Google Scholar]
  8. Wernecke K., Vassallo P., Peters P. E., von Bassewitz D. B. Mediastinal tumors: biopsy under US guidance. Radiology. 1989 Aug;172(2):473–476. doi: 10.1148/radiology.172.2.2664870. [DOI] [PubMed] [Google Scholar]
  9. Westcott J. L. Percutaneous needle aspiration of hilar and mediastinal masses. Radiology. 1981 Nov;141(2):323–329. doi: 10.1148/radiology.141.2.7291553. [DOI] [PubMed] [Google Scholar]
  10. Westcott J. L. Percutaneous transthoracic needle biopsy. Radiology. 1988 Dec;169(3):593–601. doi: 10.1148/radiology.169.3.3055026. [DOI] [PubMed] [Google Scholar]
  11. Yang P. C., Luh K. T., Sheu J. C., Kuo S. H., Yang S. P. Peripheral pulmonary lesions: ultrasonography and ultrasonically guided aspiration biopsy. Radiology. 1985 May;155(2):451–456. doi: 10.1148/radiology.155.2.3885310. [DOI] [PubMed] [Google Scholar]
  12. Yang P. C., Luh K. T., Wu H. D., Chang D. B., Lee L. N., Kuo S. H., Yang S. P. Lung tumors associated with obstructive pneumonitis: US studies. Radiology. 1990 Mar;174(3 Pt 1):717–720. doi: 10.1148/radiology.174.3.2406780. [DOI] [PubMed] [Google Scholar]
  13. Yu C. J., Yang P. C., Chang D. B., Wu H. D., Lee L. N., Lee Y. C., Kuo S. H., Luh K. T. Evaluation of ultrasonically guided biopsies of mediastinal masses. Chest. 1991 Aug;100(2):399–405. doi: 10.1378/chest.100.2.399. [DOI] [PubMed] [Google Scholar]
  14. vanSonnenberg E., Casola G., Ho M., Neff C. C., Varney R. R., Wittich G. R., Christensen R., Friedman P. J. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology. 1988 May;167(2):457–461. doi: 10.1148/radiology.167.2.3357956. [DOI] [PubMed] [Google Scholar]

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