Mediastinal masses: alternative approaches to CT-guided needle biopsy.

PURPOSE: To determine how the use of alternative anatomic approaches to mediastinal masses in biopsies guided with computed tomography (CT) affects success and complication rates.

MATERIALS AND METHODS: The medical records and imaging studies in 36 consecutive patients who underwent percutaneous mediastinal biopsy were reviewed. Alternative techniques to avoid penetration of the visceral pleura during biopsy of mediastinal masses were used in 12 patients. These included a pleural space approach through pleural effusion or iatrogenic pneumothorax, lateral decubitus positioning, and direct semicoronal scanning to guide suprasternal biopsy.

RESULTS: Adequate material for diagnosis was obtained in 34 of 36 patients (94%), 22 of 22 biopsies (100%) of anterior mediastinal masses, six of eight biopsies (75%) of middle mediastinal masses, and six of six biopsies (100%) of posterior mediastinal masses. Pneumothorax occurred in two of 36 patients (6%); this low complication rate was associated with infrequent use of the transpulmonary approach.

CONCLUSION: CT guidance can enable an individualized approach to a mediastinal mass to avoid penetration of the visceral pleura, large blood vessels, and bronchial tree and thereby lower the rate of complications.