Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

Abstract

SummarySuperior vena cava syndrome (SVCS) is secondary to obstruction of venous flow from the superior vena cava to the right atrium. Endovascular stenting is particularly useful when severe or rapidly progressive disease requires urgent treatment. In suspected mediastinal malignancy, transcaval biopsy can be combined with endovenous stenting to provide diagnosis and treatment in a single procedure. Three patients were referred for investigation and treatment of SVCS over a 20 month period. Under fluoroscopic guidance Cook Medical transjugular biopsy sets (with 20-gauge QuickCore biopsy needles) were used and two or three core biopsy samples were obtained. Stents were utilised to treat SVC obstructions in two of three patients. Obtained samples were adequate for histological diagnosis. Diagnoses included small cell and small cell neuroendocrine carcinoma of the lung. No procedural complications were encountered. Importantly, no further invasive diagnostic procedures were required. This is a safe and effective alternative to obtain a histological diagnosis in malignant SVCS and in the appropriate clinical setting biopsy can be combined with SVC stenting in a single procedure.

An initial experience of computed tomography-guided trans superior vena caval biopsy: a novel approach for precarious mediastinal lesions

“…The technical intricacies of the percutaneous biopsy are compounded by the needle traversing through 4 layers of pleura and the extensive length of lung parenchyma, the dangerous site of the lesion surrounded by major viscera, and the cumulative time for the target needle placement, which in turn depends upon the operator’s expertise [ 3 ]. Technical innovations to minimize the chances of these complications such as use of thin-bore needles and fluoroscopy-guided endovascular needle biopsy have been described in the literature [ 4 - 6 ]. In this article, we would like to put forward a novel technique that we employed successfully in performing biopsies of 3 precarious mediastinal lesions.…”

RE: Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

“…We read with interest the recent article by Maingard et al . where they described the use of transcaval biopsy and stenting in malignant superior vena caval syndrome to achieve both a diagnostic and therapeutic goal in a single sitting.…”

“…RE: Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment Dear Editor, We read with interest the recent article by Maingard et al 1 where they described the use of transcaval biopsy and stenting in malignant superior vena caval syndrome to achieve both a diagnostic and therapeutic goal in a single sitting. Recently, a 67-year-old man presented with chronic cough and facial swelling for 3-weeks duration.…”