Evaluation of trans thoracic invasive diagnostic procedures in 50 adult patients of mediastinal diseases

Siddhartha Biswas, Rama Saha, Jaydip Deb, Prothoma Dey


Introduction: Mediastinum is a “Pandora’s box” with many neoplastic and nonneoplastic lesions. Clinico-radiological pattern of mediastinal diseases depends on the size, location and etiology. Hence, non-invasive approach to these cases sometimes leads to diagnostic dilemma. Aims: A prospective study was performed over a 1-year period with the objective of evaluation of diagnostic yields and risk of trans thoracic ultra sound (TTUS) and computed tomography (CT) guided fine‑needle aspiration cytology (FNAC) and Tru-cut biopsy along with comparison of cost-effectiveness among mediastinal diseases where clinical and non-invasive imaging could not conclude the diagnosis. Materials and Methods: A prospective study of mediastinal diseases of the adult population without having any diagnosis admitted in a tertiary care hospital in Eastern India was performed after clearance of the ethical committee of the institute. Fifty cases of mediastinal diseases were seen during the study period. One patient sometimes had undergone more than one procedure. The choice of a procedure depended upon the location of the lesion, nature of disease and complication and cost effectiveness ofthe procedures. During the calculation of diagnostic yield of procedure, conclusive results and concordant results to more invasive procedures were considered. Results: Among 50 patients diagnostic yield of TTUS guided FNA and Tru-cut biopsy were 60% and 63.6% respectively. Diagnostic yield of Thoracic CT guided FNA and Tru-cut biopsy were 85% and 92.3% respectively. As a whole TTUS guided invasive procedure and Thoracic CT guided invasive procedure had a diagnostic yield of 61.5% and 87.9% respectively. Complication is less in CT guided invasive procedures (9.1%) compared to Transthoracic USG guided invasive procedures (11.5%) and complication is more common in Tru-Cut biopsy (16.7%) than fine needle aspiration (5.7%). Conclusion: Tru-cut biopsy if applicable is much superior to FNAC for a definite diagnosis of the mediastinal diseases. TTUS guided invasive procedures are very much cost-effective and have added advantage of real time guidance and is comparable with CT guided invasive procedures in respect to risk and diagnostic yields.

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Standring Susan, Gray’s Anatomy.The Anatomical Basis of Clinical Practice, Expert Consult. Churchill Livingstone. 40th ed: pp:939

Banister LH. The respiratory system. In Williams PL (ed):Gray’s Anatomy. New York: Churchil Livingstone; 1995. pp.1627-82.

Laurent F, Latrabe V, Lecesne R, Zennaro H, Airaud JY, Rauturier JF, et al. Mediastinal masses: diagnostic approach.Eur Radiol. 1998;8(7):1148-59. DOI:10.1007/ s0033 00050525

Tomiyama N, Honda O, Tsubamoto M, Inoue A, Sumikawa H, Kuriyama K, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol. 2009; 69 (2): 280-8.doi:10.1016/j. ejrad. 2007. 10. 002

Broaddus VC, Martin TR, King TE, Schraufnagel DE. Murray and Nadel's textbook of respiratory medicine. Mason RJ, editor. Elsevier Saunders; 2010;4th edition: Vol II, pp-1814-1835.

Annessi V, Paci M, Ferrari G, Sgarbi G. Ultra-sonically guided biopsy of anterior mediastinal masses. Interact Cardiovascul Thorac Surg. 2003;2(3): 319-21.

Gupta S, Seaberg K, Wallace MJ, Madoff DC, Morello FA Jr, Ahrar K, et al. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiograph. 2005; 25(3):763-786. doi:10.1148/rg.253045030

Tscheikuna J, Suttinont P. Is cytology necessary in diagnosis of mediastinal mass? J Med Assoc Thai. 2009; 92(2):S24-S29.

Hsu WH, Chiang CD, Hsu JY, Kwan PC, Chen CL, Chen CY. Ultrasonically guided needle biopsy of anterior mediastinal masses: Comparison of carcinomatous and non‐carcinomatous masses. J Clinic Ultrasound. 1995;23(6):349-356.

Rubens DJ, Strang JG, Fultz PJ, Gottlieb RH. Sonographic guidance of mediastinal biopsy: an effective alternative to CT guidance. AJR. Am J Roentgenol. 1997;169(6):1605-1610.doi: 10.2214/ajr. 169. 6. 9393174.

Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol. 2007; 35(11): 705-709. doi:10. 1002/dc. 20738

Deb J, Saha R, Chaudhury T, Chaudhury L, Ghosh I. Transthoracic cutting needle biopsy: a valuable diagnostic procedure. J Indian Med Associat. 2008; 106(4): 243-244.

Zafar N, Moinuddin S. Mediastinal needle biopsy. A 15‐year experience with 139 cases. Cancer. 1995;76 (6): 1065-1068. doi:https:// doi.org/10. 1002/1097-0142 (19950915) 76:6<1065:: AID-CNCR 2820760622> 3.0. CO; 2-M

Protopapas Z, Westcott JL. Transthoracic hilar and mediastinal biopsy. Radiol Clin North Am. 2000;38 (2): 281–291.

Wiersema MJ, Vazquez-Sequeiros E, Wiersema LM, et al Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiol. 2001; 219(1): 252–257.doi: https:// doi.org /10. 1148/ radiology. 219. 1. r01ap 44252

Gupta S, Wallace MJ, Morello FA Jr, Ahrar K, Hicks ME. CT-guided percutaneous needle biopsy of intrathoracic lesions by using the transsternal approach: experience in 37 patients. Radiol. 2002;222(1):57-62. doi:10.1148/radiol.2221010614

Shaheen MZ, Sardar K, Murtaza HG, Safdar SS, Hafeez A, Mushtaq MA, et al. CT guided trans-thoracic fine needle aspiration/biopsy of mediastinal and hilar mass lesions: An experience of pulmonology department at a tertiary care teaching hospital. Pak J Chest Med. 2008;12:26-38.

Petranovic M, Gilman MD, Muniappan A, Hasserjian RP, Digumarthy SR, Muse VV, et al. Diagnostic Yield of CT-Guided Percutaneous Trans-thoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses. AJR Am J Roentgenol. 2015; 205 (4): 774-779. doi: 10.2214/AJR.15.14442.

Morrissey B, Adams H, Gibbs AR, Crane MD. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax. 1993;48(6):632-637. doi:10. 1136/thx.48.6.632

Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image‐guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagnostic Cytopathol. 2007;35(11):705-9. doi: https://doi.org/10. 1002/ dc.20738

Rosenberger A, Adler OB. Fine-needle aspiration biopsy of mediastinal masses. A new approach to diagnosis. Isr J Med Sci. 1981;17(1):49-52.

Adler OB, Rosenberger A, Peleg H. Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences. AJR Am J Roentgenol. 1983;140 (5):893-896. doi:10.2214/ajr.140.5.893

Pedersen OM, Aasen TB, Gulsvik A. Fine needle aspiration biopsy of mediastinal and peripheral pulmonary masses guided by real-time sonography. Chest. 1986;89(4):504-508. doi:10.1378/chest.89.4.504.

Dubashi B, Cyriac S, Tenali SG. Clinico-pathological analysis and outcome of primary mediastinal malignancies—a report of 91 cases from a single institute. AnnalThorac Med. 2009;4(3):140-142 .doi: 10.4103/ 1817-1737.53354

Neyaz Z, Lal H, Thakral A, Nath A, Rao RN, Verma R. Percutaneous computed tomography-guided aspiration and biopsy of intrathoracic lesions: Results of 265 procedures. Lung India: official organ of Indian Chest Society. 2016;33(6):620.doi: 10.4103/0970-2113. 192863

Nasit JG, Patel M, Parikh B, Shah M, Davara K. Anterior mediastinal masses: A study of 50 cases by fine needle aspiration cytology and core needle biopsy as a diagnostic procedure. South Asian J Cancer. 2013;2(1):7-13. doi: 10.4103/2278-330X. 105872.

Saha D, Deb J. Diagnostic role of ultra sound and computed tomography guided fine-needle aspiration cytology and Tru-cut biopsy experienced in 50 adult patients of mediastinal diseases. J Associat Chest Physicians. 2015; 3(2):48-52.doi: 10.4103/2320-8775. 158850

Tscheikuna J, Suttinont P. Is cytology necessary in diagnosis of mediastinal mass? J Med Assoc Thai. 2009; 92(2):S24-S29.


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