CTGUIDED TRANSTHORACIC MEDIASTINAL BIOPSY'

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CT-GUIDED TRANSTHORACIC MEDIASTINAL BIOPSY.

• Pramot Tanutit M.D.
• Jitpreedee Sungsiri M.D.
• Nattakamol Maneenual
• Montanan Rohitopakarn M.D.
• Department of Radiology, Prince of Songkla U.
  Hat Yai, Songkla,Thailand.

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Introduction

• Most common mediastinal mass is lymph node.
• Morphologic imaging techniques such as CT is
  unreliable.
• Thoracic CT for detecting mediastinal nodal
  metastasis
• Sensitivity 52-75
• Specificity 65-79

N Engl J Med. 2000343254-261
Ann Thorac Surg. 1999681022-1028.
Chest. 2000117773-778.
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• Imaging-guided percutaneous core-needle biopsy is
  modality of choice for diagnosing mediastinal
  masses.
• Approaches parasternal, suprasternal,
  transsternal , paravertebral and transpulmonary.

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• Salinoma window technique
• Iatrogenic-controlled pneumothorax
• Pneumothorax
• Incidentally puncture of the internal mammary
  vessels, life-threatening.

J Thorac Imaging. 1999 Apr14(2)99-100
Radiology 1995, Vol 196, 703-706
Cardiovasc Intervent Radiol 199316259261
AJR Am J Roentgenol 1990 15447-49.
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Purpose

• Assess diagnostic yield and complications of
  CT-guided transthoracic mediastinal biopsy.
• Compare diagnostic yield and complications
  between extrapleural and transpulmonary access.

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Materials and methods

• Between January 2003 and December 2004.
• Inclusion criteria
• Mediastinal mass.
• Hilar mass.
• Lung mass attach the mediastinum.
• 34 cases
• 21 cases extrapleural access.
• 13 cases transpulmonary access.
• 18 G and 20 G Trucut- coaxial needles.

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Results and discussion

• Age
• 18-83 years old ( 55.8 years).
• Sex
• Male 24 patients.
• Female 10 patients.

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Results and discussion

• Size short-axis diameter
• 1.6 cm 11 cm ( 5.1 cm )
• Location
• Anterior mediastinum 19 Pts.
• Posterior mediastinum 12 Pts.
• Hilum 3
  Pts.

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Results and discussion

• Approaches
• Anterior 11
  Pts.
• Anterior parasternal 7 Pts.
• Posterior 6
  Pts.
• Posterior paravertebral 10 Pts.
• Accesses
• Extrapleural 21
  Pts.
• Intrapulmonary 13 Pts.

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Results and discussion

• Tissue sufficiency 33/34 (97)
• Benign (10) Thyroid goiter(3) Chronic
  granulomatous inflammation(2) Thymoma(2),
  Bronchogenic cyst(1) Extramedullary
  hematopoiesis(1) Invasive aspergillosis(1)
• Malignancy (23) Metastases(21),
  Lymphoma(1),Pleomorphic sarcoma(1)

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• 84 ( n90 ) Garbagnati F, et al Eur J Radiol.
  1989.
• 77.5 (n89) Joseph B, et al. Chest 2002.
• Transsternal approach 91
• Sanjay G, et al Radiology 2002
• Salinoma technique 91- 93
• Brian W, et al Ann Thorac Surg 2002.
• Iatrogenic-controlled pneumothorax 100(n6)
• Wein BB, Dickgreber NJ, Gunther RW. Rofo. 1997

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Case that inadequate Hurthle cell carcinoma of
thyroid
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Complications

• Intrapulmonary(13)
  Extrapleural(21)
• None 4(30.8) 20(95)
• Pneumothorax 7(53.8) 1(5)
• Hemoptysis 3(23) 0(0)
• No mediastinal hematoma or hemothorax.
• Two cases had serious pneumothorax ICD
  insertion and intervention.

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• Transthoracic mediastinal biopsy
• Pneumothorax 10-60
• Moderate Pneumothorax 1
• Iatrogenic-controlled pneumothorax
• Pneumothorax 10
• Salinoma technique
• Pneumothorax 10
• Mediastinoscopy (1-3) may be severe, general
  anesthesia.

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Conclusion

• CT-guided transthoracic mediastinal biopsy is a
  high diagnostic yielded procedure.
• The extrapleural approach is very safety access.

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THANK YOU FOR YOUR ATTENTION
L T O O V U E
R A N D A M A N Thailand
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