Navin Patrick J, Eickstaedt Nathan L, Atwell Thomas D, Young Jason R, Eiken Patrick W, Welch Brian T, Schmitz John J, Schmit Grant D, Johnson Matthew P, Moynagh Michael R
Department of Radiology, Mayo Clinic, Rochester, MN.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2021 Nov 25;5(6):1100-1108. doi: 10.1016/j.mayocpiqo.2021.09.006. eCollection 2021 Dec.
To retrospectively evaluate the safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy.
Retrospective review of an institutionally maintained biopsy registry identified 337 computed tomography- or ultrasound-guided percutaneous mediastinal mass core needle biopsies between October 2002 and August 2017 in a single quaternary referral center. Mean patient age was 51 (range, 18 to 93) years. Procedural techniques, anticoagulation/antiplatelet therapy, and tumor anatomical characteristics were reviewed. Classification and gradation of complications was based on the Clavien-Dindo system. Diagnostic yield was defined as the ratio of diagnostic biopsy to all biopsies performed.
Mean tumor size was 59.2 (range, 10 to 180) mm with 89.9% (n=303) of lesions located in the prevascular (anterior) mediastinum. There was a single major complication (0.3%) of a symptomatic pneumothorax requiring intervention. There were seven (2.1%) minor complications, including three bleeding complications. A transpleural approach was the only variable associated with an increased complication rate (<.01). Forty-one (12.2%) patients had a biopsy performed while taking an antiplatelet/anticoagulant agent within the therapeutic window, with a single case (0.3%) associated with a minor bleeding complication. Of 18 (5.3%) procedures performed without cessation of anticoagulant/antiplatelet therapy, there were no bleeding complications. Of all 337 biopsies, 322 (95.5%) were diagnostic. None of the analyzed variables were significantly associated with a nondiagnostic biopsy.
Image-guided percutaneous core-needle biopsy of mediastinal masses is a safe procedure with high diagnostic yield. Further prospective studies are required to assess the complication profile in higher risk patients.
回顾性评估经皮影像引导下纵隔肿块粗针活检的安全性和有效性。
对一家机构维护的活检登记处进行回顾性研究，确定了2002年10月至2017年8月期间在单一四级转诊中心进行的337例计算机断层扫描或超声引导下经皮纵隔肿块粗针活检。患者平均年龄为51岁（范围18至93岁）。回顾了操作技术、抗凝/抗血小板治疗以及肿瘤解剖特征。并发症的分类和分级基于Clavien-Dindo系统。诊断率定义为诊断性活检与所有进行的活检之比。
肿瘤平均大小为59.2毫米（范围10至180毫米），89.9%（n = 303）的病变位于血管前（前）纵隔。有1例主要并发症（0.3%）为有症状气胸，需要干预。有7例（2.1%）轻微并发症，包括3例出血并发症。经胸入路是唯一与并发症发生率增加相关的变量（<.01）。41例（12.2%）患者在治疗窗内服用抗血小板/抗凝剂时进行了活检，其中1例（0.3%）与轻微出血并发症相关。在18例（5.3%）未停止抗凝/抗血小板治疗的操作中，无出血并发症。在所有337例活检中，322例（95.5%）为诊断性。分析的变量均与非诊断性活检无显著相关性。
影像引导下经皮纵隔肿块粗针活检是一种安全的操作，诊断率高。需要进一步的前瞻性研究来评估高危患者的并发症情况。
