Diagnostic and safety value of ultrasound-guided transthoracic core needle biopsy for mediastinal masses: a single-center experience

Abstract

Purpose

US-guided (Ultrasound-guided) percutaneous transthoracic core needle biopsy (CNB) is a favorable method for establishing the correct diagnosis of mediastinal masses. However, studies in this area are scant and often include small samples, thus making it difficult to provide robust evidence regarding the safety and efficacy of this procedure. Thus, we aimed to report on the 20 years of experience at our center with regard to US-guided CNB.

Materials and Methods

We included all consecutive patients referred to our center to undergo US-guided percutaneous transthoracic CNB for a mediastinal mass between 1999 and 2022. Descriptive statistics were used to display data. A multivariate logistic regression analysis was used to inquire about predictors of diagnostic sampling.

Results

The final cohort included 140 patients with a median age of 37 years. In 20.7% of the cases, the mediastinal mass was an incidental finding. The parasternal approach was used most often. US-guided CNB was diagnostic in 84.3% of the patients and most of the diagnoses included hematological neoplasms. The reasons for non-diagnostic sampling included firm lesion consistency, low quantity of samples, and lesion necrosis. The parasternal approach resulted in an independent predictor of diagnostic sampling (AOR 4.16, 95% CI 1.14–15.23, p=0.031), while a bulky feature revealed only a trend for diagnostic sampling. One non-severe adverse event occurred, with spontaneous resolution.

Conclusion

US-guided percutaneous transthoracic CNB is an effective and safe procedure that allows the diagnosis of mediastinal masses. The identification of patients that could benefit from this technique should be the next step in researching this topic.

Zusammenfassung

Ziel

Die ultraschallgestützte (US-gestützte) perkutane transthorakale Stanzbiopsie (CNB: core needle biopsy) ist eine geeignete Methode für die Diagnosestellung bei mediastinalen Raumforderungen. Dementsprechende Studien sind jedoch rar und umfassen oft nur kleine Stichproben, was es schwierig macht, solide Evidenz für die Sicherheit und Wirksamkeit dieses Verfahrens zu erheben. Daher wollten wir über die 20-jährige Erfahrung in unserem Zentrum mit der US-gestützten CNB berichten.

Material und Methoden

Wir schlossen alle aufeinanderfolgenden Patienten ein, die zwischen 1999 und 2022 an unser Zentrum zu einer US-gestützten perkutanen transthorakalen CNB aufgrund mediastinaler Raumforderungen überwiesen wurden. Die Darstellung der Daten erfolgte mittels deskriptiver Statistik. Eine multivariate logistische Regressionsanalyse wurde angewandt, um Prädiktoren für eine diagnostische Biopsie zu ermitteln.

Ergebnisse

Die Studienkohorte umfasste 140 Patienten mit einem Durchschnittsalter von 37 Jahren. In 20,7% der Fälle war die mediastinale Raumforderung ein Zufallsbefund. Am häufigsten wurde der parasternale Zugang verwendet. Die US-gestützte CNB war bei 84,3% der Patienten zur Diagnose geeignet und ergab am häufigsten hämatologische Neoplasien. Die Gründe für eine nicht zu Diagnosezwecken geeignete Biopsie waren: feste Konsistenz der Läsion, eine geringe Probenmenge und Läsionsnekrose. Der parasternale Zugang erwies sich als unabhängiger Prädiktor für eine erfolgreiche diagnostische Biopsie (AOR 4,16, 95%-KI 1,14–15,23, p=0,031), während ein „bulky“ Marker nur eine Tendenz darstellte. Es kam zu einem geringfügigen unerwünschten Ereignis, das sich spontan zurückbildete.

Schlussfolgerung

Die US-gestützte perkutane transthorakale CNB ist ein effektives und sicheres Verfahren für die Diagnose von mediastinalen Raumforderungen. Die Identifizierung von Patienten, die von dieser Technik profitieren könnten, sollte der nächste Schritt der Forschung sein.

Keywords

ultrasound-guided biopsy - core needle biopsy - contrast-enhanced ultrasound - mediastinum

Publication History

Received: 15 January 2024

Accepted after revision: 18 December 2024

Article published online:
07 February 2025

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