Elsevier

Lung Cancer

Volume 25, Issue 3, September 1999, Pages 169-173
Lung Cancer

Percutaneous core needle biopsy in the diagnosis of mediastinal tumors

https://doi.org/10.1016/S0169-5002(99)00053-7Get rights and content

Abstract

Objective: to determine the contribution of percutaneous core cutting needle biopsy (PCNB) in the diagnosis of mediastinal tumors. Design: retrospective review of 70 patients with mediastinal lesions who underwent CT-guided PCNB between 1988 and 1996. Results: PCNB provided adequate material in 62/70 cases, giving a total sample rate of 88.6%. Of these 62 patients, 57 were diagnosed correctly by PCNB whereas 5/62 were misdiagnosed as nonspecific inflammation, providing an overall sensitivity of 91.9%. PCNB established a specific histologic diagnosis in 90.3% of the patients, mainly in cases of lymphoma, bronchogenic carcinoma, and thymoma. Pneumothorax was the most commonly encountered complication (11%). Hemoptysis (30–50ml) occurred in only one (1.6%) of the patients. Conclusion: CT guided PCNB is an easy and safe procedure which can provide a precise diagnosis in the majority of mediastinal tumors and can obviate the need for exploratory thoracic surgery in cases which are medically treatable or non-resectable.

Introduction

Radiologically guided transthoracic needle biopsy has become an accepted technique in the assessment of mediastinal lesions. This method may highlight the need for more invasive diagnostic procedures, such as mediastinoscopy, thoracoscopy, or exploratory thoracotomy [1], [2], [3]. Most clinicians use fine needle aspiration (FNA) to provide a sample which is usually adequate for cytological and microbiological examination, but not for a histological specimens for which core-cutting needles are used [4]. A larger volume of tissue obtained by percutaneous core needle biopsy (PCNB) allows for more sophisticated laboratory analysis, such as electron microscopy, flow cytometry, immunocytochemistry, and surface tumor markers, all of which increase diagnostic specificity [5], [6], [7].

In this study, we report the contribution of the percutaneous core needle biopsy as the initial invasive diagnostic procedure in the management of patients with mediastinal tumors.

Section snippets

Material and methods

We performed a retrospective analysis of CT-guided consecutive biopsies performed for initial evaluation of mediastinal tumors in 70 patients between 1988 and 1996. The age of the patients ranged from 25 to 82 years (mean 55). There were 41 females and 29 males.

The lesions presented roentgenologically as solid homogenous masses in 65 (92%) of the cases and as nonhomogeneous infiltrations in 7 (8%). Their diameters ranged from 1 to 10 cm, and most of them (67.9%) were larger than 4 cm. The

Results

A total of 70 patients with mediastinal tumors underwent PCNB during the study period. Of these patients, eight (three lymphomas, two thymomas, and three teratomas) were excluded because of inadequate specimen material, leaving a study group of 62 patients (an effective sample rate of 88.6%).The final diagnoses were as follows: lymphoma (n=30), thymoma (n=6), bronchogenic carcinoma (n=16), metastatic (non bronchogenic) carcinoma (n=7), and one each of teratoma, germ cell tumor, and

Discussion

Mediastinal tumors are traditionally diagnosed by mediastinoscopy, thoracoscopy or exploratory thoracic surgery. These procedures require anesthesia and hospitalization. The purpose of this study was to evaluate the clinical utility of PCNB in the diagnosis of these tumors and to determine if it should be the initial diagnostic procedure in these cases.

Between 1988 and 1996, we examined a total of 70 mediastinal tumors. Most of the tumors (89%) were located in the anterior compartment. The most

References (14)

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1

Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

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