Imaging guided mediastinal percutaneal core biopsy--technique and complications

Prior research has shown that mediastinal lesions require accurate diagnostic methods. It was already known that percutaneous biopsy techniques can provide tissue samples for histological analysis. However, no prior work had resolved the comparative safety and efficacy of ultrasound versus computed tomography guidance. This gap motivated the need to evaluate both imaging modalities in a clinical setting. The literature suggests that imaging-guided procedures reduce procedural risks. Yet, uncertainty remained about the optimal technique for mediastinal biopsy. No prior work had resolved the incidence of complications with each guidance method. This study aimed to address these unresolved questions in a real-world clinical context.

The study aimed to assess the accuracy and safety of image-guided percutaneous core biopsy of mediastinal lesions. It sought to compare ultrasound and computed tomography as guidance methods. The specific problem addressed was the lack of consensus on which imaging modality is superior. The motivation stemmed from the need to optimize diagnostic yield while minimizing complications. The authors wanted to determine the success rates of first-attempt biopsies. They also aimed to evaluate the incidence of major and minor complications. The study focused on the role of hydrodissection and artificial pneumothorax in reducing risks. The goal was to establish best practices for mediastinal biopsy procedures.

The study included 165 percutaneous biopsies of mediastinal lesions in 156 patients. Ultrasound guidance was used in 40 cases, and computed tomography in 125 cases. Post-biopsy computed tomography scans were performed to detect complications. Hydrodissection was applied in five cases to avoid lung puncture. Artificial pneumothorax was used in three cases for the same purpose. Tissue adequacy was assessed for histological diagnosis. Complication rates were tracked across imaging modalities. The study evaluated the need for repeat procedures in inadequate cases. The procedure success rate and complication incidence were the primary outcomes.

Adequate tissue was obtained in 156 of 165 cases (94.5%) at the first attempt. Nine cases required repeat procedures (5.5%). No major complications were reported in any case. Minor complications occurred in 23 cases (13.9% of total). Ultrasound-guided procedures had no complications. Computed tomography-guided procedures had 17 pneumothorax cases (10.3% of all complications). Four hemothorax cases and two hemoptysis cases were also reported. Ten pneumothorax cases were self-limited, while three required aspiration. Four cases needed pleural drainage. Pneumothorax was more frequent with multiple needle passes and larger needles.

The authors propose that image-guided percutaneous core biopsy is an accurate and safe diagnostic method. They suggest that ultrasound guidance is the preferred technique when feasible. The advantages include real-time needle control and noninvasiveness. The study supports the use of hydrodissection and artificial pneumothorax to avoid lung injury. The authors state that computed tomography guidance is suitable when ultrasound is not possible. The high success rate and low complication rate support its use as a first-choice procedure. The findings suggest that ultrasound is the gold standard for guidance in appropriate cases. The authors conclude that this technique enables reliable tissue sampling from all mediastinal compartments.