The direct approach to posterior mediastinal masses by fine-needle biopsy.

Fine-needle biopsy (FNB) is helpful in establishing an accurate cyto-histopathologic diagnosis of posterior mediastinal masses, which, on conventional radiography and with other imaging methods, may remain unclear. By doing so it initiates adequate patient management and therapy in the interest of improved prospects of cure. FNB was carried out in 55 patients with a wide variety of posterior mediastinal masses. The technique included percutaneous transthoracic FNB by a direct approach as well as FNB by the paravertebral approach with or without previous mediastinography. In 28 of 55 patients a neurogenic tumor could be diagnosed; 8 of these tumors (30%) proved to be malignant. In 14 patients, cystic lesions were detected, and in 13 patients a spectrum of other changes was found. Complications were minor and not essentially different as compared to the total material of 2,726 patients with 5,300 FNBs, with the exception that fewer pneumothoraces occurred (10 vs. 27%). In 2 patients, treatment was necessary (one suction by needle and one chest drainage). In the rest of the patients, observation during the post-biopsy period was utilized and the clinical follow-up was unremarkable.