title: Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes.
abstract: OBJECTIVE
  To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum.
  
  
  METHODS
  Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage.
  
  
  RESULTS
  Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved.
  
  
  CONCLUSIONS
  Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.
authors.affiliation: Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo, Egypt. tantawyw@yahoo.com
authors.forename: Wahid H
authors.initials: WH
authors.lastname: Tantawy
authors.forename: Emad H
authors.initials: EH
authors.lastname: El-Gemeie
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Ibrahim
authors.forename: Mona A
authors.initials: MA
authors.lastname: Mohamed
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008206:Lymphatic Diseases / Q000451:nursing*; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis*; D008875:Middle Aged; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult