Abstract
BACKGROUND--A number of reports of radiologically guided percutaneous biopsy of mediastinal masses have been described but techniques have varied, particularly the type of needle used. In this study mediastinal biopsies with fine aspiration needles and cutting needles have been compared, sometimes in the same patient. The results are reviewed with particular emphasis on the choice of biopsy needle and its influence on pathological diagnosis. METHODS--A retrospective review was undertaken of radiologically guided mediastinal biopsies performed between 1981 and 1991. RESULTS--Sixty fine needle aspiration biopsies (FNA) and 34 Tru-Cut biopsies of mediastinal masses were performed in 75 patients with fluoroscopic or computed tomographic guidance. Overall sensitivity and specificity in terms of diagnosis of malignant disease were 90% and 100% respectively for FNA biopsies, and 96% and 100% for Tru-Cut biopsies. Diagnostic accuracy in terms of precise diagnosis of the malignant or benign nature of a mass and its origin was 77% for FNA biopsies and 94% for Tru-Cut biopsies. For FNA biopsies sensitivity and accuracy were higher for carcinomatous lesions (96% and 88%) than for noncarcinomatous lesions (81% and 69%). The only significant complication encountered was a pneumothorax following a biopsy which required intercostal drainage. CONCLUSIONS--Radiologically guided percutaneous needle biopsy is a safe procedure which provides useful diagnostic information in the majority of cases. Fine needle aspiration techniques usually suffice for carcinomatous lesions but a cutting needle biopsy should be performed whenever possible when lymphoma, thymoma, or neural masses are suspected to obtain larger specimens for more accurate histological diagnosis.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 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]
- Herman S. J., Holub R. V., Weisbrod G. L., Chamberlain D. W. Anterior mediastinal masses: utility of transthoracic needle biopsy. Radiology. 1991 Jul;180(1):167–170. doi: 10.1148/radiology.180.1.1647039. [DOI] [PubMed] [Google Scholar]
- Moinuddin S. M., Lee L. H., Montgomery J. H. Mediastinal needle biopsy. AJR Am J Roentgenol. 1984 Sep;143(3):531–532. doi: 10.2214/ajr.143.3.531. [DOI] [PubMed] [Google Scholar]
- 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]
- Sawhney S., Jain R., Berry M. Tru-Cut biopsy of mediastinal masses guided by real-time sonography. Clin Radiol. 1991 Jul;44(1):16–19. doi: 10.1016/s0009-9260(05)80219-3. [DOI] [PubMed] [Google Scholar]
- 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]
- Weisbrod G. L. Percutaneous fine-needle aspiration biopsy of the mediastinum. Clin Chest Med. 1987 Mar;8(1):27–41. [PubMed] [Google Scholar]
- 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]
- 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]
- 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]