Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences

Experience with 136 fine-needle aspiration biopsies of mediastinal masses performed in 84 patients is reviewed. Biopsies were performed in all compartments of the mediastinum regardless of age. The biopsy technique included a 22-gauge needle with limitation of needle passes to an arbitrary number of three. The biopsy procedure was guided by either fluoroscopy or computed tomography (CT); guidance by CT is advantageous in the region of the thoracic inlet, hilum, and middle mediastinum, in small mediastinal masses, and in patients with superior vena cava syndrome. In 67 patients (79.7%) a specific cytologic diagnosis was obtained; in seven patients (8.3%), despite the presence of cells in the cytologic specimen, diagnosis could not be assessed. In the other 10 patients (11%), the samples obtained did not contain any cells. Morbidity was low: Light complications occurred in 15 patients (16.6%); drainage of pneumothorax was necessary in only three more. Bronchoscopy provided histology in three patients out of 12, mediastinoscopy established histologic diagnosis in 10 patients out of 16; surgery to remove the mass was performed in 38 patients. It is believed that fine-needle aspiration biopsy should be the first invasive procedure in the workup for diagnosing the nature of a mediastinal mass.