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DOI: 10.1055/s-2008-1081279
Mediastinal, Hilar, and Pleural Image-Guided Biopsy: Current Practice and Techniques
Publication History
Publication Date:
23 July 2008 (online)
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ABSTRACT
Cross-sectional imaging of the chest with computed tomography (CT), magnetic resonance imaging, and at times, ultrasonography exquisitely delineates mediastinal, hilar, and pleural pathologies. The treatment of patients with these pathologies is often based on the results of image-guided biopsies. CT and ultrasonography have been used successfully for targeting and sampling mediastinal, hilar, and pleural masses, with high sensitivity and near-perfect specificity. These procedures are performed by interventional radiologists in an outpatient setting with local anesthesia and conscious sedation. Major complications are rare, and the minor complications seen are easily managed. Minimally invasive, image-guided biopsy often obviates the need for more invasive procedures such as thoracoscopy or mediastinoscopy.
KEYWORDS
Image-guidance - biopsy - mediastinal - hilar - pleural
REFERENCES
- 1 Morrissey B, Adams H, Gibbs A R, Crane M D. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax. 1993; 48 632-637
- 2 Protopapas Z, Westcott J L. Transthoracic hilar and mediastinal biopsy. Radiol Clin North Am. 2000; 38 281-291
- 3 Westcott J L. Transthoracic needle biopsy of the hilum and mediastinum. J Thorac Imaging. 1987; 2 41-48
- 4 Protopapas Z, Westcott J L. Transthoracic needle biopsy of mediastinal lymph nodes for staging lung and other cancers. Radiology. 1996; 199 489-496
- 5 Moulton J S, Moore P T. Coaxial percutaneous biopsy technique with automated biopsy devices: value in improving accuracy and negative predictive value. Radiology. 1993; 186 515-522
- 6 Sawhney S, Jain R, Berry M. Tru-Cut biopsy of mediastinal masses guided by real-time sonography. Clin Radiol. 1991; 44 16-19
- 7 Wiersema M J, Vazquez-Sequeiros E, Wiersema L M. Evaluation of mediastinal lymphadenopathy with endoscopic US-guided fine-needle aspiration biopsy. Radiology. 2001; 219 252-257
- 8 Toloza E M, Harpole L, Detterbeck F, McCrory D C. Invasive staging of non-small cell lung cancer: a review of the current evidence. Chest. 2003; 123(1 Suppl) 157S-166S
- 9 Lloyd C, Silvestri G A. Mediastinal staging of non-small-cell lung cancer. Cancer Control. 2001; 8 311-317
- 10 Kennedy M P, Jimenez C A, Bruzzi J F et al.. Endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax. 2008; 63 360-365
- 11 Yasufuku K, Chiyo M, Koh E et al.. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer. 2005; 50 347-354
- 12 Belfiore G, Camera L, Moggio G, Vetrani A, Fraioli G, Salvatore M. Middle mediastinum lesions: preliminary experience with CT-guided fine-needle aspiration biopsy with a suprasternal approach. Radiology. 1997; 202 870-873
- 13 Bressler E L, Kirkham J A. Mediastinal masses: alternative approaches to CT-guided needle biopsy. Radiology. 1994; 191 391-396
- 14 D'Agostino H B, Sanchez R B, Laoide R M et al.. Anterior mediastinal lesions: transsternal biopsy with CT guidance. Work in progress. Radiology. 1993; 189 703-705
- 15 Gupta S, Gulati M, Rajwanshi A, Gupta D, Suri S. Sonographically guided fine-needle aspiration biopsy of superior mediastinal lesions by the suprasternal route. AJR Am J Roentgenol. 1998; 171 1303-1306
- 16 Gupta S, Wallace M J, Morello Jr F A, Ahrar K, Hicks M E. CT-guided percutaneous needle biopsy of intrathoracic lesions by using the transsternal approach: experience in 37 patients. Radiology. 2002; 222 57-62
- 17 Langen H J, Klose K C, Keulers P, Adam G, Jochims M, Gunther R W. Artificial widening of the mediastinum to gain access for extrapleural biopsy: clinical results. Radiology. 1995; 196 703-706
- 18 vanSonnenberg E, Casola G, Ho M et al.. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology. 1988; 167 457-461
- 19 Rubens D J, Strang J G, Fultz P J, Gottlieb R H. Sonographic guidance of mediastinal biopsy: an effective alternative to CT guidance. AJR Am J Roentgenol. 1997; 169 1605-1610
- 20 Yang P C, Chang D B, Lee Y C, Yu C J, Kuo S H, Luh K T. Mediastinal malignancy: ultrasound guided biopsy through the supraclavicular approach. Thorax. 1992; 47 377-380
- 21 Astrom K G, Ahlstrom K H, Magnusson A. CT-guided transsternal core biopsy of anterior mediastinal masses. Radiology. 1996; 199 564-567
- 22 Gupta S, Seaberg K, Wallace M J et al.. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics. 2005; 25 763-786 discussion 786-788
- 23 Nakajima T, Yasufuku K, Iyoda A et al.. The evaluation of lymph node metastasis by endobronchial ultrasound-guided transbronchial needle aspiration: crucial for selection of surgical candidates with metastatic lung tumors. J Thorac Cardiovasc Surg. 2007; 134 1485-1490
- 24 Fenton K N, Richardson J D. Diagnosis and management of malignant pleural effusions. Am J Surg. 1995; 170 69-74
- 25 Renshaw A A, Dean B R, Antman K H, Sugarbaker D J, Cibas E S. The role of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Chest. 1997; 111 106-109
- 26 Aerts J G, Delahaye M, van der Kwast T H, Davidson B, Hoogsteden H C, van Meerbeeck J P. The high post-test probability of a cytological examination renders further investigations to establish a diagnosis of epithelial malignant pleural mesothelioma redundant. Diagn Cytopathol. 2006; 34 523-527
- 27 Porcel J M, Vives M, Esquerda A, Salud A, Perez B, Rodriguez-Panadero F. Use of a panel of tumor markers (carcinoembryonic antigen, cancer antigen 125, carbohydrate antigen 15–3, and cytokeratin 19 fragments) in pleural fluid for the differential diagnosis of benign and malignant effusions. Chest. 2004; 126 1757-1763
- 28 Abrams L D. A pleural-biopsy punch. Lancet. 1958; 1 30-31
- 29 Cope C. New pleural biopsy needle; preliminary study. J Am Med Assoc. 1958; 167 1107-1108
- 30 Jimenez D, Perez-Rodriguez E, Diaz G, Fogue L, Light R W. Determining the optimal number of specimens to obtain with needle biopsy of the pleura. Respir Med. 2002; 96 14-17
- 31 Kirsch C M, Kroe D M, Azzi R L, Jensen W A, Kagawa F T, Wehner J H. The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy. Chest. 1997; 112 702-706
- 32 Poe R H, Israel R H, Utell M J, Hall W J, Greenblatt D W, Kallay M C. Sensitivity, specificity, and predictive values of closed pleural biopsy. Arch Intern Med. 1984; 144 325-328
- 33 Salyer W R, Eggleston J C, Erozan Y S. Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura. Chest. 1975; 67 536-539
- 34 Von Hoff D D, LiVolsi V. Diagnostic reliability of needle biopsy of the parietal pleura: a review of 272 biopsies. Am J Clin Pathol. 1975; 64 200-203
- 35 Achatzy R, Beba W, Ritschler R et al.. The diagnosis, therapy and prognosis of diffuse malignant mesothelioma. Eur J Cardiothorac Surg. 1989; 3 445-447 discussion 448
- 36 Ruffie P, Feld R, Minkin S et al.. Diffuse malignant mesothelioma of the pleura in Ontario and Quebec: a retrospective study of 332 patients. J Clin Oncol. 1989; 7 1157-1168
- 37 Maskell N A, Gleeson F V, Davies R J. Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomised controlled trial. Lancet. 2003; 361 1326-1330
- 38 Adams R F, Gray W, Davies R J, Gleeson F V. Percutaneous image-guided cutting needle biopsy of the pleura in the diagnosis of malignant mesothelioma. Chest. 2001; 120 1798-1802
- 39 Benamore R E, Scott K, Richards C J, Entwisle J J. Image-guided pleural biopsy: diagnostic yield and complications. Clin Radiol. 2006; 61 700-705
- 40 Adams R F, Gleeson F V. Percutaneous image-guided cutting-needle biopsy of the pleura in the presence of a suspected malignant effusion. Radiology. 2001; 219 510-514
Kamran AhrarM.D.
Section of Interventional Radiology, Unit 325, The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd., Houston, TX 77030
Email: kahrar@mdanderson.org