title: Diagnostic Yield of CT-Guided Percutaneous Transthoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the diagnostic yield and accuracy of CT-guided percutaneous biopsy of anterior mediastinal masses and assess prebiopsy characteristics that may help to select patients with the highest diagnostic yield.
  
  
  METHODS
  Retrospective review of all CT-guided percutaneous biopsies of the anterior mediastinum conducted at our institution from January 2003 through December 2012 was performed to collect data regarding patient demographics, imaging characteristics of biopsied masses, presence of complications, and subsequent surgical intervention or medical treatment (or both). Cytology, core biopsy pathology, and surgical pathology results were recorded. A per-patient analysis was performed using two-tailed t test, Fisher's exact test, and Pearson chi-square test.
  
  
  RESULTS
  The study cohort included 52 patients (32 men, 20 women; mean age, 49 years) with mean diameter of mediastinal mass of 6.9 cm. Diagnostic yield of CT-guided percutaneous biopsy was 77% (40/52), highest for thymic neoplasms (100% [11/11]). Non-diagnostic results were seen in 12 of 52 patients (23%), primarily in patients with lymphoma (75% [9/12]). Fine-needle aspiration yielded the correct diagnosis in 31 of 52 patients (60%), and core biopsy had a diagnostic rate of 77% (36/47). None of the core biopsies were discordant with surgical pathology. There was no statistically significant difference between the diagnostic and the nondiagnostic groups in patient age, lesion size, and presence of necrosis. The complication rate was 3.8% (2/52), all small self-resolving pneumothoraces.
  
  
  CONCLUSIONS
  CT-guided percutaneous biopsy is a safe diagnostic procedure with high diagnostic yield (77%) for anterior mediastinal lesions, highest for thymic neoplasms (100%), and can potentially obviate more invasive procedures.
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Milena
authors.initials: M
authors.lastname: Petranovic
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Gilman
authors.affiliation: 2 Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.affiliation: 3 Department of Pathology, Massachusetts General Hospital, Boston, MA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Hasserjian
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Subba R
authors.initials: SR
authors.lastname: Digumarthy
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Victorine V
authors.initials: VV
authors.lastname: Muse
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Amita
authors.initials: A
authors.lastname: Sharma
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.affiliation: 1 Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND 202, Boston, MA 02114.|4 Present address: Department of Radiology, M. D. Anderson Cancer Center, Houston, TX.
authors.forename: Carol C
authors.initials: CC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008175:Lung Neoplasms / Q000175:diagnosis*; D008223:Lymphoma / Q000175:diagnosis; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013953:Thymus Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT-guided biopsy; anterior mediastinal masses