Azrumelashvili T, Mizandari M, Magalashvili D, Dundua T
Tbilisi State Medical University, High Technology Medical Center - University Clinic; Clinic Cortex, Tbilisi, Georgia.
Georgian Med News. 2015 May(242):24-34.
165 percutaneous biopsies of anterior, middle and posterior mediastinum lesions were performed to 156 patients. Procedure was guided by US in 40 cases, by CT - in 125 cases. Hydrodissection was used in 5 cases, artificial pneumothorax - in 3 cases in order to avoid transpulmonary needle pass. Post-biopsy CT scan was performed and patients observed for any complications. Adequate tissue for histological diagnosis was obtained in 156 (94.5%) cases at the first attempt; in 9 (5.5%) cases the repeated procedure was needed. No major complications were detected after biopsy procedures; minor complications (pneumothorax, hemothorax and hemophtysis) were detected in 23 (13.9%) cases. No complications were detected after US guided procedures; In 17 (10.3% of all complications) cases pneumothorax, in 4 (2.4%) cases - hemothorax and in 2 (1.2%) cases hemophtisis was detected on CT guided procedures. All hemothorax and hemophtisis and 10 pneumothorax cases happened to be self-limited; in 3 pneumothorax cases aspiration and in 4 cases - pleural drainage was needed. Percutaneous image-guided core biopsy of mediastinal lesions is an accurate and safe procedure, which enables to get the tissue material from all mediastinum compartments. Ultrasound is the most efficient for biopsy guidance, if the target is adequately imaged by it; the advantages of US guidance are: a) possibility of real-time needle movement control b) possibility of real-time blood flow imaging b) noninvasiveness c) cost-effectiveness d) possibility to perform the biopsy at the bedside, in a semiupright position; so, ultrasound is a "Gold Standard" for procedure guidance if the 'target" can be adequately imaged by this technique. If US guidance is impossible biopsy should be performed under CT guidance. Hydrodissection and artificial pneumothorax enables to avoid the lung tissue penetration related complications. Pneumothorax was associated with multiple Needle passes and larger diameter needle use. The safety and biopsy procedure success high rate proves the use of IGMPCB as a first choice procedure when the mediastinal mass morphology is needed.
对156例患者进行了165次经皮前纵隔、中纵隔和后纵隔病变活检。40例手术由超声引导，125例由CT引导。5例使用水分离术，3例使用人工气胸以避免经肺穿刺针道。活检后进行CT扫描，并观察患者有无并发症。156例（94.5%）首次穿刺即获得足够组织用于组织学诊断；9例（5.5%）需要重复操作。活检术后未发现严重并发症；23例（13.9%）发现轻微并发症（气胸、血胸和咯血）。超声引导下操作未发现并发症；CT引导下操作发现17例（占所有并发症的10.3%）气胸，4例（2.4%）血胸，2例（1.2%）咯血。所有血胸和咯血及10例气胸均为自限性；3例气胸需要抽吸，4例需要胸腔引流。经皮影像引导下纵隔病变粗针活检是一种准确、安全的操作，能够从所有纵隔区域获取组织材料。如果目标能够被超声充分成像，超声是活检引导最有效的方法；超声引导的优点有：a）可实时控制针的移动；b）可实时进行血流成像；b）无创性；c）成本效益高；d）可在床边半卧位进行活检；因此，如果该技术能够充分成像“目标”，超声是操作引导的“金标准”。如果无法采用超声引导，活检应在CT引导下进行。水分离术和人工气胸可避免与肺组织穿刺相关的并发症。气胸与多次穿刺及使用较大直径的针有关。安全且活检操作成功率高证明，当需要了解纵隔肿块形态时，影像引导下经皮纵隔粗针活检可作为首选操作。
