Percutaneous Mediastinal Biopsy

Background and indications

CT-guided percutaneous mediastinal biopsy enables histological diagnosis of mediastinal masses and adenopathies (thymoma, lymphoma, germ cell tumor, metastasis, sarcoidosis) not accessible by mediastinoscopy or EBUS bronchoscopy. Access is via parasternal, paravertebral, or transsternal approach depending on lesion location.

Pre-procedure assessment

Assessment includes contrast-enhanced chest CT, coagulation panel, and multidisciplinary discussion. Puncture trajectory is carefully planned to avoid major mediastinal vessels, heart, and lung.

Procedure

Under local anesthesia and sedation, a coaxial needle is inserted under CT guidance. The anterior parasternal approach is most common for anterior mediastinal masses. 3 to 5 cores are obtained with an 18G biopsy needle. The procedure takes 20 to 40 minutes.

Results and scientific evidence

Percutaneous mediastinal mass biopsy offers 85-95% diagnostic yield, allowing histological and immunohistochemical subtyping in most cases. It avoids surgical mediastinoscopy in over 80% of situations.

Risks and complications

Pneumothorax (5-10%), local pain (10%), mediastinal hematoma (< 1%). Major complications (hemomediastinum, major vascular injury) are exceptional with rigorous trajectory planning.

Recovery

Monitoring for 2-4 hours with control radiograph. Results within 5-10 days.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist.