Contrast-enhanced US-guided percutaneous biopsy of anterior mediastinal lesions

Abstract

A nterior mediastinal tumors are common in clinical settings. Common lesions include inflammatory vs. neoplastic lesions, benign vs. malignant lesions, and primary vs. metastatic lesions. Among these, lymphomas are medically treatable, thymomas are surgically treatable, and metastatic carcinomas are nonresectable (1). Primary mediastinal tumors represent only about 3% of the tumors within the chest wall. Metastatic carcinoma and non-Hodgkin's lymphoma are among common anterior mediastinal tumors. The rates of nonsurgical tumors such as lymphoma are higher than the rates of surgical diseases such as thymomas (2). Some anterior mediastinal tumors such as nonseminomatous germ cell tumors, thymic carcinomas, seminomas, lymphomas, and thymomas are quite similar in medical imaging appearance, but are quite different in treatment strategy; early and precise histopathologic diagnosis of anterior mediastinal lesions is essential for correct therapeutic decision, and remains an interesting diagnostic challenge (3).Several biopsy techniques and approaches have been previously described and are available to obtain specimens of anterior mediastinal lesions, including percutaneous image-guided core needle biopsy, parasternal anterior mediastinotomy, endoscopic ultrasonography (US)-guided biopsy, video-assisted thoracoscopic surgery, cervical mediastinoscopy, and open surgical procedures (1). Most of those procedures require intubation and general anesthesia. Open biopsy is associated with morbidity, chance of pleural dissemination, and poor long-term results. For these reasons, surgically strategies are not suitable for anterior mediastinum lesions (4).In general, US-guided percutaneous core needle biopsy is the first diagnostic choice because it is a minimally invasive, safe, and cost-effective procedure. I N T E R V E N T I O N A L R A D I O LO G Y O R I G I N A L A R T I C L E PURPOSEWe aimed to explore the value of contrast-enhanced ultrasonography (CEUS) in guidance of percutaneous biopsy of anterior mediastinal lesions. METHODSNinety patients with solitary anterior mediastinal lesions (55 males, 35 females; mean age, 46±4 years) were included. Patients were randomly divided into CEUS group (n=45) and conventional ultrasonography (US) group (n=45). Real-time US-guided core needle (16 G) percutaneous biopsies were performed in all lesions. The display of internal mammary arteries, internal necrosis, and active areas were recorded and compared. Biopsy success rate and diagnostic accuracy were compared between the two groups. RESULTSDisplay rate of unenhanced internal necrosis was higher in the CEUS group than in the US group (88.9% vs. 46.7%, P = 0.041). With real-time CEUS guidance, internal mammary arteries were effectively displayed and avoided during biopsies in 68.9% of the lesions (31/45). Of the lesions, 88.9% (80/90) were histologically proven, including 13 benign lesions and 67 malignancies. There was a significant difference in the rate of successful puncture attempts between the two groups (P = 0.041). CEUS gro...

Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses

“…Successful biopsy of AMMs and the achievement of a conclusive histological diagnosis with subclassification or genetic information are crucial for prompt treatment decisions in the era of personalized therapy [ 25 ]. The present and previous studies showed high diagnostic yields and low morbidity in the group that underwent US-CNB for AMMs [ 14 , 15 , 19 , 26 , 27 ]. All of these studies approved US as a standard guidance for biopsy procedures if AMMs can be imaged well by US.…”

Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay

“…In this systematic review, potential indications for CEUS‐guided biopsy were divided into 3 main categories: (1) biopsy from perfused areas to avoid necrosis; (2) biopsy of poorly visualized or downright “invisible” lesions; and (3) additional benefits from CEUS in relation to US‐guided biopsy. A total of 19 articles were identified …”

“…By directing the biopsy needle toward contrast‐enhanced areas within the target lesion, inadvertent sampling from necrotic parts of the tumor can be reduced. This strategy resulted in a 10% to 15% increase in diagnostic accuracy by a decrease in the false‐negative rate . The principle of this technique was first described in 2000 by Bang et al, in a small feasibility study using Levovist (Schering AG, Berlin, Germany) and real‐time sampling from enhancing areas.…”

“…This article was 1 of only 3 randomized studies identified in our systematic review. The 2 other studies with a randomized design were dealing with liver and mediastinal lesions, respectively, investigating the use of real‐time CEUS‐guided biopsy compared to guidance by conventional US . The patients, 90 in the mediastinal study and 181 in the liver study, were referred for percutaneous biopsy, prospectively included, and randomized to the US‐ or CEUS‐guided technique.…”

Chinese multidisciplinary expert consensus: Guidelines on percutaneous transthoracic needle biopsy

“…It is usually used for the biopsy of superficial lesions adjacent to the thoracic wall . Contrast‐enhanced ultrasound can clearly show tumor blood vessels and necrotic lesions, which can partially reduce the false‐negative rates of needle biopsy …”