Percutaneous core needle biopsy in the diagnosis of mediastinal tumors
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.
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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
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Cited by (37)
Thymic Tumors
2018, IASLC Thoracic OncologyPathology of the mediastinum. Case 4. Type B2 thymoma
2015, Annales de PathologieRole of combined <sup>18</sup>F-FDG-PET/CT for predicting the WHO malignancy grade of thymic epithelial tumors: A multicenter analysis
2013, Lung CancerCitation Excerpt :This is particularly true when the radiological characteristics are in favor of a non-lymphomatous disease and the surgical versus non-surgical treatment decision-making process is at stake. Those who do not support the usefulness of this procedure argue that tissue/cell acquisition is (too) often not supportive for a final diagnosis [20] and also that a small (although not negligible) risk of complications [21] and, more rarely, neoplastic seeding is present [22]. Supporters, on the other hand, [23,24] believe that pre-operative histological confirmation of all mediastinal masses is mandatory, even in those cases where scarce doubts exist at imaging.
Management of anterior mediastinal masses in adults
2012, Revue des Maladies RespiratoiresSurgical Approaches for Invasive Tumors of the Anterior Mediastinum
2010, Thoracic Surgery ClinicsCitation Excerpt :In a Japanese series by Watanabe and colleagues,6 the diagnostic accuracy in histologic definition of anterior mediastinal masses has been reported higher for parasternal mediastinotomy if compared with fine needle and core biopsy. Although the diagnostic yield of percutaneous needle biopsy has been reported in some experiences7–9 between 71.3% and 100%, most investigators10,11 conclude that this technique can be useful in many cases of carcinoma and thymoma, but is generally not sufficiently accurate for the characterization of lymphoma, thus advocating the need for a surgical approach. In 2002, the authors reported a series of 46 patients with anterior mediastinal masses undergoing anterior mediastinotomy under local anesthesia with the use of mediastinoscope in case of tumors not abutting the anterior chest wall.5
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Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.