Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

Abstract

Background and objectives The high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low-and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital. Methods This descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined. Results In all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No postprocedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (<3 cm) in one patient and small pneumomediastinum in two patients. Conclusion Ultrasound-guided transthoracic mediastinal biopsy may be the pragmatic technique of choice in LMICs for the diagnosis of mediastinal masses as they provide real-time visualization and is cost-effective and safe.

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

“… 13 Currently, image-guided PCNB of AMMs, including US, CT and MRI, has been verified to be a minimally invasive and relatively safe procedure. 9 , 14 , 15 , 16 , 17 , 18 …”

“… 8 The diagnostic yield of US-guided PCNB of AMMs ranged from 79% to 100%. 5 , 8 , 15 , 19 , 20 The pathological tissue obtained by PCNB represents only a small part of the lesion, and the tissue composition in different parts of the same lesion may vary greatly. Obtaining adequate tissue specimens representing the essential characteristics of the lesion is essential to improve the diagnostic yield and accuracy of PCNB.…”