Mediastinal tumors: biopsy under US guidance.

Abstract

Percutaneous biopsies of mediastinal tumors were successfully performed under sonographic guidance in 14 of 21 patients. In 10 of 11 malignant lesions, malignancy was determined by means of cytologic and histologic examination of the specimens obtained. A histologic diagnosis was reached in seven patients with malignant mediastinal tumors, including all four cases of Hodgkin lymphoma. Mediastinal biopsy under sonographic guidance is a technically simple, rapid, and accurate procedure, but its application is limited to tumors of the anterior mediastinum.

Computed tomography-guided biopsy of mediastinal lesions: fine versus cutting needles

“…The absolute contraindications include uncontrollable cough and suspicion of hydatid cyst, whereas relative contraindications include bleeding diathesis, vascular lesions, pulmonary hypertension, uncooperative patient, and advanced emphysema 4 . Fluoroscopy, CT, and more recently ultrasound can guide the punctures 5,6 . The last method has the advantage of real-time imaging, but is limited in the evaluation of parts of mediastinum hidden by bone or air.…”

Ultrasonogram–guided Fine Needle Aspiration Cytology in Mediastinum and Lung Lesions

“…Reported rates range from 0% as studied by Karl Wernecke et al 6 to 49% by Berquist et al 17 In our series, 1 case (1.4%) showed minimal pneumothorax in post-procedural chest x-ray which resolved by itself. This could be explained by a meticulous approach to obtain a sample.…”

“…The advent of new technology like fluoroscopy, ultrasonography, and CT scan provide documentation of the needle in the mass lesion. 3,5,6 Ultrasonography (USG) is gaining acceptance as an effective guidance modality, even for difficult and small intrathoracic lesions. Several recently published articles have illustrated the role of ultrasonography as the "undiscovered jewel of interventional radiology".…”

Sonographically guided fine-needle aspiration biopsy of superior mediastinal lesions by the suprasternal route.

“…We found suprasternalbiopsy particularly useful for superior mediastinal masses in the right paratracheal and pretracheal regions; such lesions, even those extending anteriorly up to the sternum, are not visualized by parasternal sonography unless they extend lat eral to the sternum. In the series reported by Wernecke et al [7], a parasternal biopsy was we could obtain an avascular needle path in most (33/38) ofour patients. In a series of 12 sonographically guided supraclavicular fine needleaspiration biopsies reported by Yang et al [10], the needle had to pass through the jugular vein in four patients, and no compli cationsoccurred.…”

“…However, the actual pass is unguided and may need to be attempted multiple times before the needle can be accurately placed. In Only limited literature is available describ ing the suprasternal route for sonographically guided mediastinal biopsy [5,7,101.Wernecke et al [7], in their series of 14 sonographically guided mediastinal biopsies, used the supraster nal approach in only one patient. Yang et al [10] used the supraclavicular approach for bi opsyof lesionsin theuppermediastinum in 12 patients; however, theexactlocations of thele sionswerenotmentioned.…”