TRANSESOPHAGEAL BIOPSY OF MEDIASTINAL AND PULMONARY TUMORS BY MEANS OF ENDOSCOPIC ULTRASOUND GUIDANCE

Objective: The aim of this study was to investigate the value of endos copic ultrasound-guided biopsy for the diagnosis of thoracic lesions, Methods: Transesophageal ultrasound-guided biopsy was performed in 29 patients with mediastinal (n = 25) or pulmonary tumors (n = 4), A flex ible echoendoscope with a 7.5 MHz curved array transducer (Pentax FG 3 2 UA, Hamburg, Germany) and a biopsy device with a fine needle (diamet er 0.8 mm) were used for all examinations, Three patients were exclude d from the analysis of the data because a definite diagnosis based on surgery or follow-up was not available, Results: Real-time visualizati on of the biopsy procedure with endoscopic ultrasound enabled accurate tissue sampling even of small mediastinal lesions with a diameter of less than 1 cm, Diagnostic material was obtained in 23 of the 26 patie nts (85%), In 3 cases (12%) non-representative biopsy material was fou nd in the specimen. The sensitivity and specificity of transesophageal biopsy in the diagnosis of malignancy were 89% and 83%, respectively. Histologic analysis of the biopsy specimens established malignancy in 17 of 23 patients, whereas benign lesions were diagnosed in 6 patient s, Endoscopic ultrasound-guided biopsy confirmed the diagnosis suggest ed by conventional diagnostic methods in 15 of 23 patients (65%), wher eas an unsuspected diagnosis was disclosed in 8 patients (35%), The re sults of the biopsy had considerable impact on the therapeutic strateg y, None of the patients had complications related to the procedure, Co nclusions: Endoscopic ultrasound-guided biopsy provides a new minimall y invasive approach to the biopsy of lesions in the posterior mediasti num and may complement surgical staging procedures.