Background: An intrathoracic mass persists after
completion of treatment in 20% of the patients treated for Hodgkin’s
disease (HD) or non-Hodgkin’s lymphoma (NHL). Gallium scan and
positron emission tomography allow for diagnosis in most cases.
However, in some patients, a pathologic examination of the residual
mass (RM) is required. The aim of this study was to evaluate the
results of a thoracoscopic approach for intrathoracic RM, as compared
with image-guided biopsies.
Patients and methods: From
1996 to 1998, 29 consecutive patients treated for NLH (n = 11) or HD
(n = 18) were referred either to radiology (group R; n = 8) or to
surgery (group S; n = 21) for biopsy of an intrathoracic RM. There
were 13 male and 16 female patients ranging in age from 15 to 56 years
(mean, 32 years). The reason for a biopsy was the inability to
determine the nature of the RM by means of radiologic examination or
scintigraphy. Biopsy was defined as successful when (1) residual
lymphoma was found in the specimen, or (2) benign tissue was found and
the patient remained disease-free after a minimal follow-up period of
12 months. A biopsy was defined as a failure when a local recurrence
occurred in a patient with a diagnosis of benign lesion.
Results: No significant procedure-related complications
occurred in either group. The mean follow-up was 26 months (range, 13
to 72 months). In group R, residual lymphoma was found in only one
patient. In group S, residual lymphoma was found in seven patients
(p = 0.5). In the seven patients of group R with a diagnosis of
benign mediastinal lesion, two patients had a local recurrence and one
had a recurrence within the abdomen. In the 15 patients of group S in
whom no residual disease was found, 1 patient had an intrathoracic
recurrence (p = 0.5) while 2 patients had recurrence in a remote
Conclusion: Despite the limited number of
patients in this series, results suggest that a thoracoscopic approach
yields better data than image-guided biopsies.