Anterior mediastinal masses - A multidisciplinary pathway for safe diagnostic procedures

Area of Science:

• Pediatric Surgery
• Thoracic Oncology
• Diagnostic Imaging

Background:

• Anterior mediastinal masses (AMM) pose diagnostic challenges in pediatric patients.
• A multidisciplinary approach is crucial for accurate diagnosis and management.
• Previous studies highlight varied diagnostic modalities and anesthetic considerations.

Purpose of the Study:

• To report a multidisciplinary diagnostic strategy for pediatric anterior mediastinal masses.
• To analyze clinical presentation, tissue diagnosis methods, and anesthetic techniques.
• To evaluate the safety and efficacy of the diagnostic approach.

Main Methods:

• Retrospective review of 44 pediatric patients with AMM (2011-2016).
• Analysis of clinical data, biopsy methods (lymph node, core, mediastinoscopic), and alternative tissue diagnoses (pleural fluid, peripheral blood).
• Review of anesthetic techniques, including spontaneous breathing, local anesthesia, and ketamine sedation.

Main Results:

• 22 of 44 patients presented with respiratory symptoms; 26 had tracheobronchial compression.
• Biopsies included lymph node (20), image-guided core (10), and mediastinoscopic (2).
• Alternative tissues yielded diagnoses in 11 patients; 14 required no or local anesthesia, with 18 managed under spontaneous breathing, primarily with ketamine sedation, and no major anesthetic complications.

Conclusions:

• A personalized, multidisciplinary approach enables safe tissue diagnosis of pediatric anterior mediastinal masses.
• Employing alternative tissues, local anesthesia, and ketamine sedation reduces the necessity for general anesthesia, muscle paralysis, and mechanical ventilation.
• This strategy enhances patient safety and diagnostic yield.