Dixit Ramakant, Shah Narender Singh, Goyal Mukesh, Patil Chetan B, Panjabi Mukesh, Gupta Rakesh C, Gupta Neeraj, Harish Sabarigiri Vasan
Department of Respiratory Medicine, J.L.N. Medical College, Ajmer, Rajasthan, India.
Department of Radiation Oncology, J.L.N. Medical College, Ajmer, Rajasthan, India.
Lung India. 2017 Jul-Aug;34(4):341-348. doi: 10.4103/lungindia.lungindia_311_16.
Mediastinum is a "Pandora's box" with many neoplastic and nonneoplastic lesions. The purpose of this study was to analyze our institutional experience of mediastinal lesions on fine-needle aspiration cytology (FNAC) and/or biopsy.
This study was an analysis of 144 patients who had undergone ultrasound-guided FNAC and/or core biopsy for mediastinal lesions.
A total of 144 cases of suspected mediastinal masses were seen, and in 139 cases, tissue diagnosis was attempted. Out of 139 cases, 93 cases were neoplastic in nature (67%), 32 were nonneoplastic (23%), and 14 remained inconclusive (10%). Among neoplastic mediastinal lesions, metastatic carcinoma (37.4%) was the most common neoplastic lesion, followed by non-Hodgkin's lymphoma (12.2%), Hodgkin's lymphoma (7.1%), thymic lesions (3.5%), etc. Among nonneoplastic conditions, tuberculosis was the most common lesion (20.1%). An accurate tissue diagnosis was made in 89.9% cases by FNAC or core biopsy of mediastinal lesions in this study. Procedure-related mortality was nil. Complications were mostly minor and included chest pain in 24.5%, small pneumothorax in 13.6% requiring closed tube thoracostomy in 1.4%, and scanty hemoptysis in 9.3% cases.
Neoplastic mediastinal lesions are more common than nonneoplastic lesions, with metastatic carcinoma being the most common cause followed by tuberculosis. A wide variety of lesions observed in this study stress on the importance of cytohistological diagnosis in all cases of mediastinal lesions for the final diagnosis and management planning. A guided FNAC or core biopsy is still accurate, well tolerated, and devoid of major complications.
纵隔是一个充满许多肿瘤性和非肿瘤性病变的“潘多拉魔盒”。本研究的目的是分析我们机构在纵隔病变细针穿刺细胞学检查（FNAC）和/或活检方面的经验。
本研究对144例因纵隔病变接受超声引导下FNAC和/或芯针活检的患者进行了分析。
共观察到144例疑似纵隔肿块，其中139例尝试进行组织诊断。在这139例中，93例为肿瘤性病变（67%），32例为非肿瘤性病变（23%），14例诊断不明确（10%）。在肿瘤性纵隔病变中，转移性癌（37.4%）是最常见的肿瘤性病变，其次是非霍奇金淋巴瘤（12.2%）、霍奇金淋巴瘤（7.1%）、胸腺病变（3.5%）等。在非肿瘤性疾病中，结核病是最常见的病变（20.1%）。本研究中，通过纵隔病变的FNAC或芯针活检，89.9%的病例获得了准确的组织诊断。与操作相关的死亡率为零。并发症大多较轻，包括胸痛24.5%、小气胸13.6%（其中1.4%需要胸腔闭式引流）、少量咯血9.3%。
肿瘤性纵隔病变比非肿瘤性病变更常见，转移性癌是最常见的原因，其次是结核病。本研究中观察到的多种病变强调了在所有纵隔病变病例中进行细胞组织学诊断对于最终诊断和治疗计划的重要性。超声引导下的FNAC或芯针活检仍然准确、耐受性良好且无重大并发症。
