What is the role of biopsy in the workup of tumors of the mediastinum?

Updated: Feb 16, 2021
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

In the past, percutaneous biopsy methods were considered too dangerous to be used in the evaluation of mediastinal masses, and open surgical biopsy was the diagnostic procedure of choice. Although still controversial, increased success using CT-guided fine-needle aspiration (FNA) and core needle biopsy techniques is reported at several centers.

Differentiation between thymomas, lymphomas, and germ cell tumors can be made in a number of cases when tissue obtained from a core needle biopsy is subjected to special histologic staining methods, including immunohistochemical techniques. In some cases, lymphoma subtypes can also be identified. Note that expert clinical judgment is necessary in selecting appropriate cases for this diagnostic method. In addition, considerable expertise in tissue processing and analysis is necessary for diagnostic accuracy.

FNA has been used occasionally to aid in the diagnosis of primary bronchogenic cysts. However, most authorities do not recommend aspiration of a cyst because a sample of the cyst wall, required for diagnosis, is not obtained by this method. Also, most cysts recur after simple aspiration. This technique is not recommended for esophageal cysts. FNA has been described for neurogenic tumors, although because surgical resection is the treatment for these lesions after adequate workup, needle biopsy may be deemed an unnecessary step. [32, 33]


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