Biopsy in cases of mediastinal lymphomas via mediastinotomy versus scalene lymph node biopsy

To assess the feasibility and accuracy of mediastinal lymph node biopsy via mediastinotomy incision and compare its accuracy with scalene lymph node biopsy in cases of mediastinal lymphomas with no palpable relevant lymph nodes. We received 20 patients with a picture suggestive of mediastinal lymphomas during the period between March, 2003 and April, 2006 at the Department of Cardiothoracic Surgery-Suez Canal University Hospitals. We received 9 male patients [45%] and 11 females [55%]. The age ranged between 18 and 56 years with average age of 31+2.1 years. Eight patients [group A] had been operated upon via mediastinotomy incisions alone to shorten the time of anaesthesia. In the other group B, 12 patients had both mediastinotomy incisions and scalene lymph node biopsies as the general condition was good in all patients. The results in both groups were compared. In group A, all the 8 patients were histopathologically diagnosed after mediastinal lymph node biopsies. The material of the biopsy was enough to help the pathologist to give the accurate diagnosis. Five patients had local intercostal nerve block and sedation but the other three tolerated short term general anaesthesia no single mortality but only one had severe chest infection which was treated successfully. In group B: All patients had biopsies of both mediastinal lymph nodes and scalene lymph nodes under general anaesthesia. No mortalities but there were excessive bleeding and wound infection-related to scalene biopsy in one patient. All samples taken from mediastinal lymph nodes were diagnostic. Scalene lymph node biopsies: Only in four cases we get the same histopathological report for the scalene LN biopsy as that of mediastinal L.N. These four patients had splenomegaly and enlarged abdominal para-aortic LN thus, we selected left-sided scalene LN biopsy. The remaining 8 reports of scalene biopsies were non-specific and non-diagnostic. Mediastinal lymph node biopsy via a mediastinotomy incision in the 2[nd] or 3[rd] left intercostal space is a safe and accurate approach to diagnose cases of mediastinal lymphadenopathy. Scalene lymph node biopsy is less specific and gives a lower diagnostic yield [40% Vs 100%]. Evaluation of sensitivity of left-sided scalene LN biopsy in cases with enlarged abdominal LN needs further studies

Thoracoscopic biopsy versus ultrasound guided biopsy to diagnose peripheral intrathoracic lesions

Now, thoracoscopy is a well-defined technique of proven value in the investigation, diagnosis and staging of different intrathoracic lesions. Also, ultrasound guided biopsy is a new diagnostic modality in this field. To document the feasibility, safety and reproducibility of thoracoscopic biopsy and compare its results with the ultrasound-guided biopsy to diagnose peripheral intrathoracic lesions. This prospective study included all patients admitted with undiagnosed intrathoracic mass lesion during the period between March 2003 to April 2005. Group A included 45 patients for whom 56 biopsy samples were taken as ultrasound- guided biopsy [11 repeated procedures]. Group B included 30 patients for whom 30 samples were taken thoracoscopically, these included 7 patients from group A who had failed ultrasound-guided biopsy. The results were compared. Group A: 45 patients, 21 males and 24 females the age ranged between 23 and 67 years, mean age was 45+6.14 years ultrasound-guided biopsy was done but repeated for 9 patients then repeated for two of the last group the diagnosis was confirmed in each case by the postoperative pathological examination of the whole resected mass. Ultrasound-guided biopsy showed sensitivity of 57%, it yielded diagnosis in 80% of the patients. The yield increased when more than one attempt was made. Also, pneumothorax occurred in 9% of cases [5 patients], heamoptysis in 3 patients and hemothorax in only one patient. Group B: 30 patients 18 males and 12 females, mean age was 42+3.12 years 7 of them had previously failed ultrasound-guided biopsy. The diagnostic yield was 100%, sensitivity 100% and specificity was 100% as well. The only complication was prolonged air leak [in 2 patients] and one case converted into thoracotomy for excessive bleeding. Thoracoscopy is highly feasible, safe and having a high diagnostic yield. Both the sensitivity and specificity of thoracoscopy are much higher than those of the ultrasound-guided biopsy. Recent technologic advances including specially designed ultrasound needles will allow more precise needle placement and will lead to a higher diagnostic lead when recent equipments become available to us. In most of the cases, both ultrasound-scanning, CT-scanning and thoracoscopy are complementary to each other to diagnose peripheral intrathoracic masses