Computed tomography-guided mediastinal biopsy: a single center’s experience focusing upon efficacy and safety

Dimitrios Filippiadis, Danai E. Stefanou, Argyro Mazioti, Alexios Kelekis, Efthymia Alexopoulou, Elias Brountzos, Nikolaos Kelekis


Purpose: The purpose of this study is to evaluate the efficacy and safety of Computed Tomography (CT)-guided mediastinal biopsy.

Material and Methods: This is a single centered retrospective study including 32 mediastinal biopsies performed during the last 24 months in a cohort of 29 patients (15 male-14 female, average age 57 years, lesions diameter ranging between 2-12 cm); 3 patients underwent  a second biopsy due to insufficient sample post the first attempt . All percutaneous biopsies were performed under local anaesthesia and CT guidance; in all cases an 18G semi-automatic soft tissue biopsy needle was used for tissue sampling.  CT scan was used for evaluation of potential complications.

Results: The histological outcome was conclusive for 26/29 patients (89.6%), whilst post the second attempt efficacy rate increased to 93.7% (27/29 patients - 30/32 biopsies). Biopsy reports included lymphoma (14 cases), bronchogenic carcinoma (10 cases), metastasis (1 case) and benign substrate (2 cases). The mean ionising rate per CT-guided biopsy was 14mGy. No complications were noted in this study according to the CIRSE classification system.

Conclusions: Imaging-guided percutaneous needle biopsy of mediastinal masses is a safe and effective technique for diagnosis of suspicious lesions. Imaging guidance and correct route selection increase efficacy and safety rates.


Computed Tomography; biopsy; mediastinum; safety; efficacy

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Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol 2007: 705-709.

Masoud R, Sarrami AH. Computed tomography-guided percutaneous core needle biopsy for diagnosis of mediastinal mass lesions: Experience with 110 cases in two university hospitals in Isfahan, Iran. Adv Biomed Res 2016; 5: 152.

Priola AM, Priola SM, Cataldi A, et al. CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 2008; 113(1): 3-15.

Petranovic M, Gilman MD, Muniappan A, et al. Diagnostic yield of CT-guided percutaneous transthoracic needle biopsy for diagnosis of anterior mediastinal masses. AJR Am J Roentgenol 2015; 205(4): 774-779.

Alda T. Mediastinal biopsy. In: Gervais, DA. and Sabharwal T, eds. Interventional radiology procedures in biopsy and drainage. Springer-Verlag London 2011; pp 31-46.

Gupta S, Seaberg K, Wallace MJ, et al. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics 2005; 25(3): 763-786; discussion 786-788.

Logaraj A, Edwards P. Transcaval biopsy of a mediastinal mass compressing the superior vena cava. Respirol Case Rep 2017; 5(2): e00213.

Laurent F, Michel P, Latrabe V, et al. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors. AJR Am J Roentgenol 1999; 172(4): 1049-1053.

Filippiadis D, Velonakis G, Kelekis A, et al. Computed tomography-guided lung biopsy with the patient in lateral decubitus position and the biopsy side down: effect on pneumothorax rate and clinical significance. Hell J Radiol 2017; 2(3): 22-29.

Moore EH, LeBlanc J, Montesi SA, et al. Effect of patient positioning after needle aspiration lung biopsy. Radiology 1991; 181(2): 385-387.

Herman SJ, Holub RV, Weisbrod GL, et al. Anterior mediastinal masses: utility of transthoracic needle biopsy. Radiology 1991; 180(1): 167-170.

Kulkarni S, Kulkarni A, Royet D, al. Percutaneous computed tomography-guided core biopsy for the diagnosis of mediastinal masses. Ann Thorac Med 2008; 3(1): 13-17.

Patel IJ, Davidson JC, Nikolic B, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol 2012; 23(6): 727-736.

Patel IJ, Davidson JC, Nikolic B et al. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol 2013; 24(5): 641-645.

Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: The Cirse classification system. Cardiovasc Intervent Radiol 2017; 40(8): 1141-1146.

Guimaraes MD, Groos JL, Chojnak R, et al. MRI-guided biopsy: a valuable procedure alternative to avoid the risks of ionizing radiation from diagnostic imaging methods. CVIR 2014; 37(3 ): 858-860.

Guimarães MD, Hochhegger B, Benveniste MFK, et al. Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging. Clinics (Sao Paulo) 2014; 69(11): 787–791.

Garnon J, Ramamurthy N, Caudrelier J et al. MRI-guided percutaneous biopsy of mediastinal masses using a large bore magnet: technical feasibility. Cardiovasc Intervent Radiol 2016; 39(5): 761-767.

Yi D, Feng M, Wen-Pinet W, et al. Contrast-enhanced US-guided percutaneous biopsy of anterior mediastinal lesions. Diagn Interv Radiol 2017; 23(1): 43–48.

Klöppel R, Wilke W, Weisse T, et al. CT-guided intervention by means of a laser marking and targeting aid. Rofo 1997; 167(2): 194-197.

Honganoor VV, Keshava SKN, Moses V, et al. CT guided biopsy using additional laser guidance: Case series from India comparing with conventional free hand technique. Egypt J Radiol Nucl Med 2016; 47(2): 493-499.


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