MEDIASTINAL NEEDLE-BIOPSY - A 15-YEAR EXPERIENCE WITH 139 CASES

Background. Radiologically guided needle biopsy and cytologic evaluati on provide a reliable method of diagnosis for planning definitive ther apy of patients with mediastinal lesions. Materials and Methods. In th is retrospective study of one of the largest series from a single inst itution, 141 consecutive mediastinal needle biopsies from 139 patients were reviewed during a 15-year period. Results. Adequate material was obtained with a diagnosis achieved in 128 cases (92%). Of these, 33 c ases (26%) had benign diagnoses; the remaining 95 (74%) had malignant diagnoses, including 81 carcinomas, 3 sarcomas, 8 lymphoproliferative lesions, 2 malignant germ cell tumors, and 1 malignant thymoma. All be nign cases were diagnostically confirmed, and 94 of 95 malignant cases were classified correctly. The only discrepancy that occurred involve d a malignant lymphoma diagnosed as a malignant germ cell tumor. Of th e 13 inadequate samples, the major category included a nodular scleros is variant of Hodgkin's disease (4 cases), 1 case of thymoma, 1 case o f tuberculous lymphadenitis, and 7 cases for which no follow-up data w ere available. Conclusion. Needle biopsy is reaffirmed as a reliable a nd sensitive diagnostic tool for mediastinal lesions, with an overall cytologic diagnostic accuracy of 99% with adequate material. Sclerotic lesions may pose a limitation to this technique and require generous sampling before a more invasive diagnostic procedure is undertaken.