SUPERIOR VENA-CAVA SYNDROME - RAPID HISTOLOGIC DIAGNOSIS BY ULTRASOUND-GUIDED TRANSTHORACIC NEEDLE ASPIRATION BIOPSY

We prospectively analyzed the diagnostic yield and safety of ultrasoun d (US)-guided transthoracic needle aspiration biopsy in the histologic diagnosis of 40 patients with superior vena cava (SVC) syndrome. Duri ng a 4-yr period, 40 patients with SVC obstruction were admitted to Na tional Taiwan University Hospital. Of these patients 10 had histologic confirmation by sputum cytology (3 patients), fiberoptic bronchoscopy with biopsy (2 patients), or lymph node biopsy (5 patients) at admiss ion. A total of 30 undiagnosed patients underwent real-time ultrasonog raphic (US) evaluation as well as color Doppler imaging. Patients with tumor detectable by US underwent US-guided transthoracic needle aspir ation biopsy. Of the 30 patients who received US chest examination, 29 had widening of the upper mediastinal shadows in the chest radiograph s. In 27 patients tumors were detected by chest US. After assessment o f collateral vessels by color Doppler US, these 27 patients underwent US-guided transthoracic needle aspiration biopsies; histologic diagnos es were confirmed in 25. The diagnostic yield was 83.3%. The mean dura tion from admission to histologic diagnosis was 2.1 days. None of the patients developed complications. We conclude that chest US and color Doppler images are useful tools for evaluation of patients with SVC sy ndrome. US-guided transthoracic needle aspiration biopsy appears to be a safe, effective, and rapid approach for obtaining an accurate histo logic diagnosis. Specific treatment can thus be initiated without dela y.