Mediastinal Staging of Non-Small-Cell Lung Cancer

Christian Lloyd, MD, and Gerard A. Silvestri, MD, FCCP, Division of Pulmonary and Critical Care Medicine at the Medical University of South Carolina, Charleston.

Cancer Control. 2001;8(4) 

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Percutaneous Transthoracic Needle Aspiration

Percutaneous transthoracic needle aspiration(PCNA) can be used to sample mediastinal lesions. A biopsy of every region of the mediastinum can be obtained with this technique.Lesions in the left mediastinum, including the para-aortic, as well as lesions in close proximity to the pulmonary artery can be sampled by PCNA. Although this may seem risky, biopsy under CT guidance is relatively safe in this region due to the relatively fixed anatomy and the direct visualization provided by CT.[32] In addition, lesions in the anterior mediastinum inaccessible by transbronchial needle aspiration or endoscopic ultrasound can be easily biopsied using PCNA.Although less used than other modalities that provide more access, PCNA can be used to biopsy subcarinal and right paratracheal lesions.

The most significant complication with PCNA is major bleeding from an inadvertent puncture of a central vessel. For this reason, any bleeding diathesis is considered a contraindication for this procedure. Likewise,pulmonary hypertension is a relative contraindication to percutaneous biopsy of a central lesion. Pneumothoraxis the most common complication from PCNA. Reports of pneumothorax noted in the literature vary widely, but most observe a frequency of 25%to 30%.[33] The risk of pneumothorax following percutaneous biopsy is influenced by the degree of concomitant pulmonary emphysema. Miller et al[34] found a 46% incidence of pneumothorax in patients with chronic obstructive pulmonary disease compared with a 7% incidence in normal patients as determined by spirometry and radiographs.

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