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Nonpulmonary thoracic biopsy.

F Garbagnati1, R Lutman, L Valvassori

  • 1Istituto Nazionale Dei Tumori, Milano.

European Journal of Radiology
|November 1, 1989
PubMed
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Computed tomography (CT) guidance is superior for thoracic extrapulmonary needle biopsy of mediastinal and thoracic wall masses. This method achieved an 84% accuracy rate, proving effective for diagnosing lesions near vascular structures.

Area of Science:

  • Thoracic Surgery
  • Diagnostic Imaging
  • Interventional Radiology

Background:

  • Distinguishing between pulmonary and extrapulmonary thoracic needle biopsies is crucial for selecting appropriate guidance methods.
  • Fluoroscopic guidance is suitable for pulmonary biopsies, while extrapulmonary lesions necessitate more precise imaging.
  • Previous studies have not clearly delineated the optimal guidance for extrapulmonary thoracic masses.

Purpose of the Study:

  • To compare fluoroscopic guidance with computed tomography (CT) guidance for thoracic extrapulmonary needle biopsies.
  • To evaluate the diagnostic accuracy and safety of CT-guided biopsies for mediastinal and thoracic wall masses.

Main Methods:

  • Retrospective analysis of 500 thoracic punctures over 5 years, focusing on 90 biopsies of mediastinal or thoracic wall masses.

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  • Exclusion of all lung parenchymal lesions.
  • CT was the primary guidance method for extrapulmonary thoracic masses, assessing lesion proximity to vascular structures and enabling extrapleural needle insertion.

    • Main Results:

    • CT guidance provided diagnostic evidence for small-diameter mediastinal lesions and facilitated accurate needle placement.
    • An overall accuracy rate of 84% was achieved for both mediastinal and thoracic wall lesions.
    • A 1% incidence of moderate pneumothorax occurred, none requiring thoracic drainage.

    Conclusions:

    • CT guidance is the preferred method for thoracic extrapulmonary needle biopsies, offering superior accuracy and safety.
    • CT enables precise localization of extrapulmonary masses and facilitates safe biopsy, even for small lesions.
    • The low complication rate supports the safety profile of CT-guided thoracic extrapulmonary needle biopsy.