Abstract
Background
Mediastinal masses span a wide histopathological and radiological spectrum. Anterior mediastinal tumors account for 50% of all mediastinal masses, including thymoma, teratoma, thyroid disease, and lymphoma. Ultrasound guidance can be used for biopsy of anterior mediastinal lesions that extend to the anterior parasternal chest wall with the advantage of being a real-time procedure and its ability to perform the biopsy at the bedside of critically ill or dyspneic patients.
Aim of the study
The aim of this study was to evaluate the efficacy and safety of using ultrasonography as a guiding modality during percutaneous biopsies for anterior mediastinal lesions.
Patients and methods
This prospective study for diagnostic accuracy was conducted on 22 patients with anterior mediastinal masses. In total, lesions in 19 patients were approached through parasternal approach under local anesthesia using lidocaine 2% and in two patients the lesions were approached through suprasternal approach. Lesion in one patient failed to be approached by either parasternal or suprasternal approach because of its deep location.
Results
Conclusive results were obtained in 18 patients (81.8%), nonconclusive results in three patients (13.6%), and biopsy was not performed for one patient (4.6%) because of technical difficulty. Malignant lymphoma was the most encountered pathological diagnosis. Two patients developed vasovagal attacks at the beginning of the procedure. No procedure-related mortality was encountered in this study.
Conclusion
Ultrasound-guided biopsy is a useful technique for anterior mediastinal lesions with a good diagnostic yield (81.8%) and minimal complications.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Laurent F, Latrabe V, Lecesne R, Zennaro H, Airaud JY, Rauturier JF, et al. Mediastinal masses: diagnostic approach. Eur Radiol 1998; 8: 1148–1159.
Tomiyama N, Honda O, Tsubamoto M, Inoue A, Sumikawa H, Kuriyama K, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol 2009; 69:280–228.
Whitten CR, Khan S, Munneke GJ, Grubnic S. A diagnostic approach to mediastinal abnormalities. Radiographics 2007; 27:657–671.
Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging 2010; 32:1325–1339.
Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L. A diagnostic approach to mediastinal masses. Insights Imaging 2013; 4: 29–52.
Erasmus JJ, McAdams HP, Donnelly LF, Spritzer CE. MR imaging of mediastinal masses. MRI Clin North America 2000; 8:59–89.
Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132:202S–220S.
Rubens DJ, Strang JG, Fultz PJ, Gottlieb RH. Sonographic guidance of mediastinal biopsy: an effective alternative to CT guidance. Am J Roentgenol 1997; 169:1605–1610.
Gupta S, Seaberg K, Wallace MJ, Madoff DC, Morello FAJr, Ahrar K, et al. Imaging-guided percutaneous biopsy of mediastinal lesions. Radiographics 2005; 25:763–786.
Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised consort statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001; 134:663–694.
Beau VD, Daniel HS, Ali IM. Tumors of the mediastinum. Chest 2005; 128:2893–2909.
Vaziri M, Abdolreza P, Leila Z. Mediastinal masses: review of 105 cases. Acta Med Iran 2009; 47:297–300.
Nasit JG, Patel M, Parikh B, Shah M, Davara K. Anterior mediastinal masses: a study of 50 cases by fine needle aspiration cytology and core needle biopsy as a diagnostic procedure. South Asian J Cancer 2013; 2:7–13.
Davis S, Rogers MAM, Pendergrass TW. The incidence and epidemiologic characteristics of neuroblastoma in the United States. Am J Epidemiol 1987; 126:1063–1074.
Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 2003; 105:546–551.
Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors: Part 1. Tumors of the anterior mediastinum. Chest 1997; 112:511.
Otani Y, Yoshida I, Ishikawa S, Ohtaki A, Kawashima O, Takahashi T, et al. Use of ultrasound-guided percutaneous needle biopsy in the diagnosis of mediastinal tumors. Surg Today 1996; 26:990–992.
Tscheikuna J, Suttinont P. Is cytology necessary in diagnosis of mediastinal mass? J Med Assoc Thai 2009; 92:s25–s29.
Shrivastava CP, Devgarha S, Ahlawat V. Mediastinal tumors: a clinicopathological analysis. Asian Cardiovasc Thorac Ann 2006; 14: 102–104.
Karki S, Chalise S. Analysis of mediastinal lesions: a study of 27 cases. J Pathol Nepal 2011; 1:114–117.
Prasnath G, Amul K, Jyoti B, Shipra A, Sanjay T, Latit K. Mediastinal masses-the bad, the ugly and the unusual!. Indian J Med Pediatr Oncol 2007; 28:11–16.
Fang WT, Xu MY, Chen G, Chen Y, Chen WH. Minimally invasive approaches for histological diagnosis of anterior mediastinal masses. Chin Med J (Engl) 2007; 120:675–679.
Desai F, Sha M, Petal S, Shukla SN. Fine needle aspiration cytology of anterior mediastinal masses. Indian J Pathol Microbiol 2008; 51:88–90.
Koh DM, Burke S, Davies N, Padley SP. Trans-thoracic US of the chest: clinical uses and applications Radiographics 2002; 22:e1.
Wernecke K, Diederich S. Sonographic features of mediastinal tumors. Am J Roentgenol 1994; 163:1356–1364.
Gupta S, Gulati M, Rajwanshi A, Gupta D, Suri S. Sonographically guided fine-needle aspiration biopsy of superior mediastinal lesions by the suprasternal route. Am J Roentgenol 1998; 171:1303–1306.
Saha D, Deb J. Diagnostic role of ultrasound and computed tomography guided fine-needle aspiration cytology and Tru-cut biopsy experienced in 50 adult patients of mediastinal diseases. J Assoc Chest Physicians 2015; 3:48–52.
Hsu WH, Chiang CD, Hsu JY, Kwan PC, Chen CL, Chen CY. Ultrasonically guided needle biopsy of anterior mediastinal masses: comparison of carcinomatous and non-carcinomatous masses. J Clin Ultrasound 1995; 23:349–356.
Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol 2007; 35:705–709.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Ali, A.A., Abd El-Hafeez, A.M., Fathallah, W.F. et al. Yield of ultrasound-guided biopsy in anterior mediastinal lesions. Egypt J Bronchol 10, 26–32 (2016). https://doi.org/10.4103/1687-8426.176662
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1687-8426.176662