Yang P C, Chang D B, Lee Y C, Yu C J, Kuo S H, Luh K T
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Republic of China.
Thorax. 1992 May;47(5):377-80. doi: 10.1136/thx.47.5.377.
Malignancies located in the upper middle mediastinum usually do not have a sufficiently large acoustic window to permit a conventional ultrasound guided parasternal biopsy. This study was concerned with an alternative approach whereby ultrasound is applied through the supraclavicular paratracheal window to allow percutaneous biopsy of middle mediastinal malignancies.
Fifteen patients who had upper mediastinal malignancies not in contact with the chest wall underwent real time and Doppler ultrasonographic studies by the supraclavicular approach. None of these tumours could be reached by conventional ultrasound guided parasternal biopsy. The ultrasound was scanned downwards through the supraclavicular fossa, along the acoustic window of the paratracheal soft tissue space. Percutaneous aspiration biopsy was performed with a 22 gauge needle under ultrasound guidance. If fine needle aspiration could not obtain an adequate tissue smear an 18 gauge Trucut biopsy was performed to obtain a histological diagnosis.
Twelve of 15 mediastinal malignancies were detected by ultrasound through the supraclavicular approach. These 12 patients underwent percutaneous needle aspiration biopsy under ultrasound guidance. Four of the patients also had a Trucut biopsy because the needle aspirates from the tumours were inadequate. The needle had to pass through the jugular veins in four patients who received fine needle aspiration but in none of the patients who required a Trucut biopsy. Definite histological diagnoses were obtained in all 12 of these patients. Ten of the tumours were malignant and two benign. None of the patients developed any complication.
Ultrasound and ultrasound guided biopsy through the supraclavicular paratracheal window provides a new approach for malignancy located in the upper middle mediastinum, which cannot be reached by conventional ultrasound guided parasternal biopsy. The diagnostic yield of this technique is high and the procedure is relatively safe.
位于中上纵隔的恶性肿瘤通常没有足够大的声学窗口来进行传统的超声引导下胸骨旁活检。本研究关注一种替代方法，即通过锁骨上气管旁窗口应用超声，以允许对纵隔中部恶性肿瘤进行经皮活检。
15例上纵隔恶性肿瘤未与胸壁接触的患者接受了锁骨上途径的实时和多普勒超声检查。这些肿瘤均无法通过传统的超声引导下胸骨旁活检到达。超声沿气管旁软组织间隙的声学窗口向下扫查锁骨上窝。在超声引导下用22号针进行经皮穿刺活检。如果细针穿刺不能获得足够的组织涂片，则进行18号Trucut活检以获得组织学诊断。
15例纵隔恶性肿瘤中有12例通过锁骨上途径的超声检测到。这12例患者在超声引导下接受了经皮针吸活检。4例患者还进行了Trucut活检，因为肿瘤的针吸物不足。4例接受细针穿刺的患者穿刺针必须穿过颈静脉，但需要进行Trucut活检的患者均未出现这种情况。这12例患者均获得了明确的组织学诊断。其中10例肿瘤为恶性，2例为良性。所有患者均未发生任何并发症。
通过锁骨上气管旁窗口的超声及超声引导下活检为位于中上纵隔的恶性肿瘤提供了一种新方法，而传统的超声引导下胸骨旁活检无法到达该部位。该技术的诊断率高且操作相对安全。
