An Innovative Management in the Diagnosis of Mediastinal Masses

The mediastinum is a complex anatomical region that contains vital structures such as the great vessels, heart, esophagus, and trachea. Mediastinal masses include a wide range of lesions, both malignant and benign. Our study aimed to evaluate whether the combination of intraoperative ultrasound (IUS) and VATS can allow obtaining an adequate, correct, and safer diagnosis in patients with a mediastinal mass, especially in severely ill patients affected by heart failure, renal failure, advanced oncological stage, and respiratory failure.

This single-center, retrospective, observational study included 298 consecutive patients with mediastinal mass, evaluated between March 2018 and December 2024 at the Thoracic Surgery Department of Vanvitelli University of Naples. All patients underwent biopsies of mediastinal masses via VATS with IUS. Mediastinal masses were classified based on their ultrasound characteristics, allowing precise identification of the site and solid part of the lesions for biopsy. No significant complications were reported.

A total of 298 patients underwent VATS for mediastinal mass biopsy. About 185 of these patients underwent biopsies via VATS with IUS. All were under general anesthesia with single-lung ventilation. A specific diagnosis was obtained in all patients who underwent biopsies via VATS with IUS (185/185), with lymphoma being the most common entity (58.6%), followed by germ cell tumors (24.3%) and thymic carcinoma (12.4%). A significant difference in diagnostic accuracy, specificity, and sensibility was found between the group that used IUS versus the group in which no IUS was used (100%vs. 93%, 99.8% vs. 94%, 98.5% vs. 90.5% respect).

IUS-guided biopsy allows for correct, safe, and precise identification of mediastinal lesions, establishing IUS as the "Gold Standard" for procedure guidance when the target lesion is adequately visualized.