title: Diagnostic impact of color Doppler ultrasound-guided core biopsy on fine-needle aspiration of anterior mediastinal masses.
abstract: Although lymphoma and thymoma are common etiologies of anterior mediastinal masses (AMMs), smaller percentages and numbers of patients with these diseases have been enrolled in previous ultrasound-guided biopsy studies. To date, there has been no study of color Doppler sonographic features to support the differentiation of AMMs. For this retrospective cohort study, a search of the database of the China Medical University Hospital using the clinical coding "ultrasound-guided biopsy" was conducted for the period December 2003 to February 2013. We selected patients diagnosed with AMMs (not cysts) using radiographic records. This search yielded a list of 80 cases. Real-time ultrasound-guided core needle biopsy (CNB) was performed in all but 5 patients without a sufficient safety range. In 89% (67/75) of these ultrasound-guided CNB cases, the diagnostic accuracy achieved subclassification. Fine-needle aspiration cytology achieved subclassification in only 10% of cases. On color Doppler sonography, 71% of lymphomas were characterized as "rich vascular with central/crisscross collocations" and 29% as "avascular or localized/scattered peripheral vessels." However, decreased proportions of "rich vascular with central/crisscross collocations" were found in lung cancer (4% [1/23], odds ratio = 0.018, 95% confidence interval: 0.002-0.154, p < 0.001) and thymoma/thymic carcinoma (25% [4/16]; odds ratio = 0.133, 95% confidence interval: 0.035-0.514, p = 0.003) compared with the lymphoma group. We conclude that the vessels in lymphoma AMMs have specific patterns on color Doppler sonography. Ultrasound-guided CNB of AMMs had an accuracy of ≤ 89% in diagnosis and subclassification. Fine-needle aspiration cytology itself cannot aid in the diagnosis. Color Doppler sonographic evaluation of AMMs followed by real-time CNB is a more efficient method.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wei-Chih
authors.initials: WC
authors.lastname: Liao
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
authors.forename: Shinn-Jye
authors.initials: SJ
authors.lastname: Liang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Li
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: hsuwh@mail.cmuh.org.tw.
authors.forename: Wu-Huei
authors.initials: WH
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
keywords: Anterior mediastinal mass; Color Doppler ultrasound; Core needle biopsy; Fine-needle aspiration; Vascularization