Biopsy of mediastinal tumors: Needle biopsy versus mediastinoscopy: Pro needle biopsy

Image-guided needle biopsy of the mediastinum is rapid, safe, and inexpensive, and does not require general anesthesia. All regions of the mediastinum are potentially accessible using this technique. The depth of the lesion does not limit the feasibility of the biopsy procedure. Unnecessary surgery can often be avoided, thereby reducing patient morbidity and shortening hospitalization. The importance of establishing a diagnosis in a nonsurgical way in patients who are not surgical candidates is clear. Many mediastinal biopsies are performed for lung cancer staging. Needle biopsy, even when using thin aspiration needles, is highly accurate in diagnosing mediastinal carcinoma. Advances in biopsy needle technology, namely the use of core biopsy needles, have enabled the yield of large tissue fragments with minimally distorted histology, facilitating the diagnosis of lymphoma and helping to establish a diagnosis in patients in whom fine-needle biopsy was nondiagnostic. Advances in immunohistochemical staining have also contributed to the diagnostic accuracy of needle biopsy in the diagnosis of lymphoma. Innovations in CT imaging, particularly CT-fluoroscopy, which is becoming more and more available, shorten the duration of the CT-guided needle biopsy procedure and enhance its accuracy. In cases of thymoma, the role of mediastinal needle biopsy is mainly to exclude other diagnoses for which treatment is nonsurgical, such as lymphoma and metastatic carcinoma. In our opinion, needle biopsy of the mediastinum should be the procedure of choice to obtain tissue diagnosis for a variety of mediastinal pathologies, particularly when the established diagnosis can obviate surgery.