To determine the accuracy and complication rate of CT-TNB for hilar or mediastinal masses or enlarged lymph nodes on CT in patients with NSCLC.
We retrospectively obtained a list of patients for whom TNB was performed over the period 1996–2004 to sample a hilar or mediastinal mass, or enlarged hilar or mediastinal lymph nodes (short axis > 10 mm) in patients with a primary lung lesion representing NSCLC. Those patients with suspected sarcoidosis or those with proven small cell carcinoma or a history of an extrathoracic malignancy who underwent TNB to detect nodal metastases from malignancies other than non-small cell lung cancer were excluded. We sought to determine the size and distribution of enlarged mediastinal and hilar lymph nodes or masses as seen on chest CT. The diagnostic yield and complication rate, in particular pneumothorax, bleeding, and chest tube insertion rate, were determined from a procedural database. The final pathologic diagnosis and TNM staging classification resulting from the biopsy was obtained from the pathology report.
There were 21 patients who underwent CT-guided biopsy of a mediastinal or hilar lesion with NSCLC. The distribution of lesions were: right paratracheal (6), hilar (8), prevascular/anterior mediastinal (4), subcarinal (2) and aortopulmonary window (1). An extra-visceral pleural approach utilizing existing parasternal or paravertebral tissue, pleural fluid, or iatrogenically-created pneumothorax was possible in 15 of 21 patients (71%). There were 20 patients proven to have mediastinal or nodal disease and one patient proven surgically to be node negative: all were correctly diagnosed by CT-guided TNB (accuracy = 100%). In all but two patients, the results of the biopsy precluded attempts at surgical resection. Three patients (14%) developed a pneumothorax, with 2 (10%) requiring catheter drainage.
CT-guided TNB is an accurate and safe technique in selected patients for nodal staging of NSCLC.
This minimally-invasive technique can guide clinicians confronted with abnormal CT scans or positron emission tomography studies for hilar and mediastinal nodes to more accurate select surgical candidates with NSCLC.
E. McQuaide, None.