The Diagnostic Yield and Safety of Ultrasound-Assisted Transthoracic Biopsy of Mediastinal Masses

Abstract

Background: Ultrasound (US)-assisted transthoracic biopsy offers a less invasive alternative to surgical biopsy in the setting of mediastinal masses. Objectives: The aim of this 1-year prospective study was to assess the diagnostic yield and safety of a novel single-session sequential approach of US-assisted transthoracic fine-needle aspirations (TTFNA) with rapid on-site evaluation (ROSE) followed by cutting needle biopsies (CNB) performed by physicians on patients with anterosuperior mediastinal masses. Methods: US-assisted TTFNA with ROSE was performed on 45 consecutive patients (49.5 ± 27.7 years, 24 males), immediately followed by CNB where a provisional diagnosis of epithelial carcinoma or tuberculosis could not be established, provided a safety range could be assured. Results: TTFNA alone was deemed adequate by means of ROSE in 27 (60%) patients. CNB could be performed in 17 of the remaining 18. The on-site diagnosis corresponded to the final diagnosis in 26/45 (57.8%). An accurate cytological diagnosis was made in 33 (73.3%), and was more likely to be diagnostic in epithelial carcinoma and tuberculosis (28/30) than all other pathologies (5/15, p < 0.001). CNB yielded a diagnosis in 15/17 (88.2%). Overall, 42/45 patients were diagnosed by the single-session approach (93.3%). The final diagnoses included 41 neoplasms, with small cell lung cancer (n = 13) the commonest diagnosis. We observed no pneumothorax or major haemorrhage. Conclusions: A single-session sequential approach of US-assisted TTFNA with ROSE followed by CNB, where indicated, has a high diagnostic yield for anterosuperior mediastinal masses, is safe and offers an alternative to surgical biopsy.

Percutaneous Ultrasound-Guided Biopsies in the Evaluation of Thoracic Tumours after PET-CT: A Prospective Diagnostic Study

“…A high efficacy of US-guided biopsies was reported in 31 out of 34 lesions in the analysis of thoracic tumours [11]. Recently, a diagnostic yield of >93% was reported in a single-session sequential approach of mediastinal masses with US-assisted transthoracal FNA (with rapid on-site evaluation) eventually followed by TCB [12]. …”

A practical guide to transthoracic ultrasound

“…In a recent study we performed ultrasonography-assisted transthoracic FNA with ROSE on patients with anterior mediastinal masses, immediately followed by CNB in cases where a provisional diagnosis of epithelial carcinoma or tuberculosis could not be established [49]. An accurate cytological diagnosis was made in 73% of cases, and was more likely to be positive in cases of epithelial carcinoma or tuberculosis than all other pathology (p,0.001).…”

Transthoracic Ultrasonography for Clinicians

“…The same investigators pioneered the supraclavicular approach for US-guided biopsies of superior mediastinal tumors (56). However, US-assisted mediastinal biopsy has not gained popularity among clinicians, presumably because investigators generally utilized only CNB and were almost exclusively interventional radiologists (57). The complication rates of the various studies range from 1% to 6%, with pneumothoraces, hemothoraces, and hemoptysis the most common serious complications.…”