Safety and Efficacy of Percutaneous Image-Guided Mediastinal Mass Core-Needle Biopsy

Abstract

Objective To retrospectively evaluate the safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy. Patients and Methods Retrospective review of an institutionally maintained biopsy registry identified 337 computed tomography– or ultrasound-guided percutaneous mediastinal mass core needle biopsies between October 2002 and August 2017 in a single quaternary referral center. Mean patient age was 51 (range, 18 to 93) years. Procedural techniques, anticoagulation/antiplatelet therapy, and tumor anatomical characteristics were reviewed. Classification and gradation of complications was based on the Clavien-Dindo system. Diagnostic yield was defined as the ratio of diagnostic biopsy to all biopsies performed. Results Mean tumor size was 59.2 (range, 10 to 180) mm with 89.9% (n=303) of lesions located in the prevascular (anterior) mediastinum. There was a single major complication (0.3%) of a symptomatic pneumothorax requiring intervention. There were seven (2.1%) minor complications, including three bleeding complications. A transpleural approach was the only variable associated with an increased complication rate ( P <.01). Forty-one (12.2%) patients had a biopsy performed while taking an antiplatelet/anticoagulant agent within the therapeutic window, with a single case (0.3%) associated with a minor bleeding complication. Of 18 (5.3%) procedures performed without cessation of anticoagulant/antiplatelet therapy, there were no bleeding complications. Of all 337 biopsies, 322 (95.5%) were diagnostic. None of the analyzed variables were significantly associated with a nondiagnostic biopsy. Conclusion Image-guided percutaneous core-needle biopsy of mediastinal masses is a safe procedure with high diagnostic yield. Further prospective studies are required to assess the complication profile in higher risk patients.

Efficacy of contrast-enhanced ultrasound-guided percutaneous core needle biopsy in anterior mediastinal masses

“…Complication rates in CT-guided procedures range from 4% to 17%. 6 A transpleural route was reported as the only variable associated with an increased complication rate by CT-guided approaches. 6 It is impossible to view the lesion when the lung tissue is between the US transducer and the lesion; therefore, US-guided procedures usually avoid this route.…”

“… 6 A transpleural route was reported as the only variable associated with an increased complication rate by CT-guided approaches. 6 It is impossible to view the lesion when the lung tissue is between the US transducer and the lesion; therefore, US-guided procedures usually avoid this route. This may be another reason for the fewer complications associated with the US-guided procedures.…”

“…In prior studies, the complication rate of the CT-guided approach ranged from 2% to 17%, while that of the US-guided approach was consistently close to zero. 6 , 7 , 8 , 9 …”

Histopathology and Immunohistochemical profile of mediastinal lymphoma in Dr. Soetomo General Hospital

“…Other study revealed there are a number of limitations. Only patients who were suitable for biopsy underwent the procedure, and the technique (including approach and biopsy gauge) was chosen by an experienced proceduralist on a case-by-case basis (Navin et al, 2021). The specimens for this study were taken from the Anatomical Pathology laboratory archives at Dr. Soetomo General Hospital, Surabaya, and most of specimens were obtained from core biopsy procedures due to their being minimally invasive and having minimal complication for patients.…”

Canadian Association of Radiologists/Canadian Association for Interventional Radiology/Canadian Society of Thoracic Radiology Guidelines on Thoracic Interventions

“…80 CT guidance is the most common modality due to its efficacy, safety and wide availability. 61,80,81 The diagnostic yield for mediastinal PTNB is 92% and accuracy is 94%. 63 Diagnostic yield is lower for residual lymphoma (57%) than for initial diagnosis or recurrence (90%).…”