TRANSTHORACIC NEEDLE-BIOPSY OF MEDIASTINAL LYMPH-NODES FOR STAGING LUNG AND OTHER CANCERS

PURPOSE: To determine the usefulness of transthoracic needle biopsy of mediastinal lymphadenopathy for staging suspected lung and other canc ers. MATERIALS AND METHODS: Transthoracic needle biopsy of the hilum o r mediastinum was performed in 111 patients with suspected neoplasms. Most biopsy procedures were performed with computed tomographic guidan ce on an outpatient basis. Forty-eight adult patients had enlarged lym ph nodes (defined as less than or equal to 30 mm in the long axis and greater than or equal to 10 mm in the short axis). Sixty-three lesions larger than 30 mm were arbitrarily considered to be masses and were e xcluded. RESULTS: Carcinoma was diagnosed in 40 patients. Four patient s had true-negative and one patient had false-negative results. Sensit ivity for carcinoma was therefore 98% (40 of 41). One patient with a n egative biopsy result did not have surgical confirmation and was exclu ded from analysis. Lymphoma was diagnosed in two patients (positive in one and suspicious in one). Pneumothorax occurred in 19 (34%) of 56 b iopsy procedures. Chest tube treatment was required in eight (14%). CO NCLUSION: Transthoracic needle biopsy of mediastinal lymphadenopathy i s a safe, accurate diagnostic staging procedure. It can frequently be used as an alternative to mediastinoscopy in patients with lymphadenop athy.