Diagnostic outcome and safety of CT-guided core needle biopsy for mediastinal masses: a systematic review and meta-analysis

  • Han Na Lee
  • Seong Jong YunEmail author
  • Jung Im Kim
  • Chang-Woo Ryu



This systematic review and meta-analysis aimed to evaluate the diagnostic outcomes and complication rates and to identify potential covariates that could influence these results for computed tomography (CT)–guided core needle biopsy (CNB) of mediastinal masses.


A computerized search of the PubMed and EMBASE databases was performed to identify original articles on the use of CT-guided CNB for mediastinal mass. The pooled proportions of the diagnostic yield and accuracy were assessed using random effects modeling. We assessed the pooled proportion of complication rates using random effects or fixed effects modeling. Multivariate meta-regression analyses were performed to evaluate the potential sources of heterogeneity.


Eighteen eligible studies (1310 patients with 1345 CT-guided CNBs) were included. The pooled proportions of the diagnostic yield and accuracy of CT-guided CNB for mediastinal masses were 92% (18 studies, 1345 procedures) and 94% (15 studies, 803 procedures), respectively. In the subgroup analysis, the pooled proportions of the total complication rate and major complication rate were 13% and 2%, respectively. In the meta-regression analyses, the number of tissue samplings (odds ratio [OR], 3.3; p = 0.03), real-time fluoroscopy-guided (OR, 2.1; p = 0.02), and percentage of lymphoma (OR, 2.2; p < 0.001) for diagnostic yield, number of tissue samplings (OR = 2.0, p = 0.02) for diagnostic accuracy, and biopsy needle diameter (OR, 2.5; p = 0.002) for total complication rate were all sources of heterogeneity.


CT-guided CNB for mediastinal mass demonstrates high diagnostic outcomes and low complication rates. The use of 20-gauge biopsy needles and obtaining ≥ 3 samples may be recommended to improve diagnostic outcomes and decrease complication rates.

Key Points

The pooled estimates of diagnostic yield and accuracy of computed tomography (CT)–guided core needle biopsy (CNB) for mediastinal masses are 92% and 94%, respectively.

The pooled estimates of the total complication rate and major complication rate were 13% and 2%, respectively.

The use of a 20-gauge needle and ≥ 3 tissue samplings are recommended for CT-guided mediastinal CNB to achieve high diagnostic outcomes and lower complication rates.


Biopsy Large-core needle Mediastinal neoplasm Computed tomography Meta-analysis 



Confidence interval


Core needle biopsy


Fine needle aspiration


Odd ratio


Preferred Reporting Items for a Systematic Review and Meta-Analysis


Quality Assessment of Diagnostic Accuracy Studies-2



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Seong Jong Yun, MD, PhD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Seong Jong Yun, MD) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because the nature of our study was a systemic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because the nature of our study was a systemic review and meta-analysis.


• Meta-analysis performed at one institution

Supplementary material

330_2019_6377_MOESM1_ESM.doc (133 kb)
ESM 1 (DOC 133 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology, Kyung Hee University Hospital at GangdongKyung Hee University School of MedicineSeoulRepublic of Korea

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