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CT-guided Percutaneous Needle Biopsy of Intrathoracic Lesions by Using the Transsternal Approach: Experience in 37 Patients¹

¹ From the Section of Vascular and Interventional Radiology, Division of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030-4009. Received March 15, 2001; revision requested April 24; revision received June 18; accepted July 5. Address correspondence to S.G.

PURPOSE: To report our experience with computed tomography (CT)-guided coaxial needle biopsy of intrathoracic lesions by using the transsternal approach.

MATERIALS AND METHODS: Medical records of 37 consecutive patients who underwent CT-guided transsternal biopsy of intrathoracic lesions were evaluated retrospectively. A coaxial needle technique was used in all patients; an 18-gauge needle was used for transsternal penetration, through which a 22-gauge needle was passed to obtain fine-needle aspirates. Five patients also underwent core-needle biopsy with a coaxially introduced 20-gauge needle. Medical records were reviewed for lesion size and location, needle path, number of needle penetrations, reasons for failure, biopsy results, and complications.

RESULTS: The transsternal approach was used in mediastinal (n = 32) or intrapulmonary (n = 5) lesions. Transsternal needle sampling of the target lesion was successful in 35 patients. In the remaining two, adequate angling of the transsternal needle could not be achieved. Extrapleural access to the mediastinal lesions was achieved in all but one patient in whom the 22-gauge needle traversed the lung. Major vessels were avoided in most patients; the 22-gauge needle was safely passed through the brachiocephalic vein in one patient with a retrotracheal mass. Thirty-two (91%) of the 35 biopsies yielded diagnostic specimens. No major complications were encountered. Minor complications were pneumothorax in one patient and mediastinal hematoma in another.

CONCLUSION: The CT-guided transsternal approach for coaxial core-needle biopsy allows safe access to masses in various locations in the mediastinum and anteromedial lung.

Index terms: Biopsies, technology • Mediastinum, biopsy, 67.126 • Mediastinum, CT, 67.1211 • Mediastinum, neoplasms, 67.315

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