Advertisement

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
Chest

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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

Abbreviations

CI

Confidence interval

CNB

Core needle biopsy

FNA

Fine needle aspiration

OR

Odd ratio

PRISMA

Preferred Reporting Items for a Systematic Review and Meta-Analysis

QUADAS-2

Quality Assessment of Diagnostic Accuracy Studies-2

Notes

Funding

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

Compliance with ethical standards

Guarantor

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.

Methodology

• Meta-analysis performed at one institution

Supplementary material

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

References

  1. 1.
    Kim H, Park CM, Lee SM, Goo JM (2015) C-arm cone-beam CT virtual navigation-guided percutaneous mediastinal mass biopsy: diagnostic accuracy and complications. Eur Radiol 25:3508–3517CrossRefGoogle Scholar
  2. 2.
    De Margerie-Mellon C, De Bazelaire C, Amorim S et al (2015) Diagnostic yield and safety of computed tomography-guided mediastinal core needle biopsies. J Thorac Imaging 30:319–327CrossRefGoogle Scholar
  3. 3.
    Date H (2009) Diagnostic strategies for mediastinal tumors and cysts. Thorac Surg Clin 19(29–35):viGoogle Scholar
  4. 4.
    Bressler EL, Kirkham JA (1994) Mediastinal masses: alternative approaches to CT-guided needle biopsy. Radiology 191:391–396CrossRefGoogle Scholar
  5. 5.
    Iguchi T, Hiraki T, Matsui Y et al (2018) CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses. Diagn Interv Imaging 99:91–97CrossRefGoogle Scholar
  6. 6.
    Rabbani M, Sarrami AH (2016) Computed tomography-guided percutaneous core needle biopsy for diagnosis of mediastinal mass lesions: experience with 110 cases in two university hospitals in Isfahan, Iran. Adv Biomed Res 5:152CrossRefGoogle Scholar
  7. 7.
    Petranovic M, Gilman MD, Muniappan A et al (2015) Diagnostic yield of CT-guided percutaneous transthoracic needle biopsy for diagnosis of anterior mediastinal masses. AJR Am J Roentgenol 205:774–779CrossRefGoogle Scholar
  8. 8.
    Kulkarni S, Kulkarni A, Roy D, Thakur M (2008) Percutaneous computed tomography-guided core biopsy for the diagnosis of mediastinal masses. Ann Thorac Med 3:13–17CrossRefGoogle Scholar
  9. 9.
    Priola AM, Priola SM, Cataldi A et al (2008) CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 113:3–15CrossRefGoogle Scholar
  10. 10.
    Shaham D, Goitein O, Vazquez MF et al (2001) Biopsy of mediastinal tumors: needle biopsy versus mediastinoscopy: pro needle biopsy. J Bronchol 8:132–138Google Scholar
  11. 11.
    Neyaz Z, Lal H, Thakral A, Nath A, Rao R, Verma R (2016) Percutaneous computed tomography-guided aspiration and biopsy of intrathoracic lesions: results of 265 procedures. Lung India 33:620–625CrossRefGoogle Scholar
  12. 12.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100CrossRefGoogle Scholar
  13. 13.
    McInnes MDF, Moher D, Thombs BD et al (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319:388–396CrossRefGoogle Scholar
  14. 14.
    Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefGoogle Scholar
  15. 15.
    Borenstein M, Hedges LV, Higgins JP, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1:97–111CrossRefGoogle Scholar
  16. 16.
    DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28:105–114CrossRefGoogle Scholar
  17. 17.
    Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration, London. Available via http://handbook.cochrane.org. Accessed 10 Jan 2019
  18. 18.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRefGoogle Scholar
  19. 19.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRefGoogle Scholar
  20. 20.
    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463CrossRefGoogle Scholar
  21. 21.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202CrossRefGoogle Scholar
  22. 22.
    Gardner D, VanSonnenberg E, D’Agostino HB, Casola G, Taggart S, May S (1991) CT-guided transthoracic needle biopsy. Cardiovasc Intervent Radiol 14:17–23CrossRefGoogle Scholar
  23. 23.
    Divisi D, Battaglia C, Crisci R et al (1998) Diagnostic and therapeutic approaches for masses in the posterior mediastinum. Acta Biomed Ateneo Parmense 69:123–128Google Scholar
  24. 24.
    Lin ZY, Li YG (2009) Artificial pneumothorax with position adjustment for computed tomography-guided percutaneous core biopsy of mediastinum lesions. Ann Thorac Surg 87:920–924CrossRefGoogle Scholar
  25. 25.
    Malone LJ, Stanfill RM, Wang H, Fahey KM, Bertino RE (2013) Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy. AJR Am J Roentgenol 200:1238–1243CrossRefGoogle Scholar
  26. 26.
    Scalzetti EM (2005) Protective pneumothorax for needle biopsy of mediastinum and pulmonary hilum. J Thorac Imaging 20:214–219CrossRefGoogle Scholar
  27. 27.
    Azrumelashvili T, Mizandari M, Dundua T, Magalashvili D (2016) Ultrasound and CT guided thoracic biopsy approaches - effectiveness and complications. Georgian Med News:32–39Google Scholar
  28. 28.
    Ghanaati H, Firouznia K, Motevalli M, Mirdamadi L, Jalali AH (2008) Fluoroscopic versus conventional computed tomography-guided biopsy. Iran J Radiol 5:39–42Google Scholar
  29. 29.
    Gorgulu FF, Oksuzler FY, Arslan SA, Arslan M, Ozsoy IE, Gorgulu O (2017) Computed tomography-guided transthoracic biopsy: factors influencing diagnostic and complication rates. J Int Med Res 45:808–815CrossRefGoogle Scholar
  30. 30.
    Khan AR, Khan MY, Javaid A, Hussain I (2010) Percutaneous image guided cutting needle biopsy of mediastinal masses: diagnostic yield and complications. J Postgrad Med Inst 24:58–61Google Scholar
  31. 31.
    VanSonnenberg E, Casola G, Ho M et al (1988) Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology 167:457–461CrossRefGoogle Scholar
  32. 32.
    Watanabe M, Takagi K, Aoki T et al (1998) A comparison of biopsy through a parasternal anterior mediastinotomy under local anesthesia and percutaneous needle biopsy for malignant anterior mediastinal tumors. Surg Today 28:1022–1026CrossRefGoogle Scholar
  33. 33.
    Westcott JL (1981) Percutaneous needle aspiration of hilar and mediastinal masses. Radiology 141:323–329CrossRefGoogle Scholar
  34. 34.
    Yadav RK, Sen R, Agarwal S, Aggarwal S (2010) CT-guided FNAC of intrathoracic mass lesions--a study among 35 patients. J Indian Med Assoc 108:571–574Google Scholar
  35. 35.
    Zamboni M, Lannes DC, Cordeiro PDB et al (2009) Transthoracic biopsy with core cutting needle (Trucut) for the diagnosis of mediastinal tumors. Rev Port Pneumol 15:589–595CrossRefGoogle Scholar
  36. 36.
    Azrumelashvili T, Mizandari M, Magalashvili D, Dundua T (2015) Imaging guided mediastinal percutaneal core biopsy--technique and complications. Georgian Med News 24–34Google Scholar
  37. 37.
    Branden E, Wallgren S, Hogberg H, Koyi H (2014) Computer tomography-guided core biopsies in a county hospital in Sweden: complication rate and diagnostic yield. Ann Thorac Med 9:149–153CrossRefGoogle Scholar
  38. 38.
    de Farias AP, Deheinzelin D, Younes RN, Chojniak R (2003) Computed tomography-guided biopsy of mediastinal lesions: fine versus cutting needles. Rev Hosp Clin Fac Med Sao Paulo 58:69–74CrossRefGoogle Scholar
  39. 39.
    Floridi C, Reginelli A, Capasso R et al (2017) Percutaneous needle biopsy of mediastinal masses under C-arm conebeam CT guidance: diagnostic performance and safety. Med Oncol:34Google Scholar
  40. 40.
    Greif J, Staroselsky AN, Gernjac M et al (1999) Percutaneous core needle biopsy in the diagnosis of mediastinal tumors. Lung Cancer 25:169–173CrossRefGoogle Scholar
  41. 41.
    Hagberg H, Ahlström HK, Magnusson A, Sundström C, Åström GK (2000) Value of transsternal core biopsy in patients with a newly diagnosed mediastinal mass. Acta Oncol 39:195–198CrossRefGoogle Scholar
  42. 42.
    Jiao D, Huang K, Wu G, Wang Y, Han X (2016) Flat detector cone-beam CT-guided percutaneous needle biopsy of mediastinal lesions: preliminary experience. Radiol Med 121:769–779CrossRefGoogle Scholar
  43. 43.
    Sklair-Levy M, Polliack A, Shaham D et al (2000) CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma. Eur Radiol 10:714–718CrossRefGoogle Scholar
  44. 44.
    Yanagawa M, Tomiyama N, Honda O et al (2010) CT-guided percutaneous cutting needle biopsy of thymic epithelial tumors. Comparison to the accuracy of computed tomographic diagnosis according to the World Health Organization classification. Acad Radiol 17:772–778CrossRefGoogle Scholar
  45. 45.
    Yokoyama K, Ikeda O, Kawanaka K et al (2014) Comparison of CT-guided percutaneous biopsy with and without registration of prior PET/CT images to diagnose mediastinal tumors. Cardiovasc Intervent Radiol 37:1306–1311CrossRefGoogle Scholar
  46. 46.
    Yousef HY, Dawood HA, Mohey N (2017) Is there any role for diffusion weighted magnetic resonance imaging before transthoracic CT guided biopsy? Egypt J Radiol Nucl Med 48:927–930CrossRefGoogle Scholar
  47. 47.
    Lim C, Lee KY, Kim YK, Ko JM, Han DH (2013) CT-guided core biopsy of malignant lung lesions: how many needle passes are needed? J Med Imaging Radiat Oncol 57:652–656CrossRefGoogle Scholar
  48. 48.
    Hiraki T, Mimura H, Gobara H et al (2009) CT fluoroscopy-guided biopsy of 1,000 pulmonary lesions performed with 20-gauge coaxial cutting needles: diagnostic yield and risk factors for diagnostic failure. Chest 136:1612–1617CrossRefGoogle Scholar
  49. 49.
    Beck KS, Kim TJ, Lee KY, Kim YK, Kang JH, Han DH (2019) CT-guided coaxial biopsy of malignant lung lesions: are cores from 20-gauge needle adequate for histologic diagnosis and molecular analysis? J Thorac Dis 11:753–765CrossRefGoogle Scholar
  50. 50.
    Eichenauer DA, Engert A, Dreyling M ESMO Guidelines Working Group (2011) Hodgkin’s lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 22(Suppl 6):vi55–vi58Google Scholar
  51. 51.
    Tilly H, Dreyling M, ESMO Guidelines Working Group (2010) Diffuse large B-cell non-Hodgkin’s lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v172–v174CrossRefGoogle Scholar
  52. 52.
    Frederiksen JK, Sharma M, Casulo C, Burack WR (2015) Systematic review of the effectiveness of fine-needle aspiration and/or core needle biopsy for subclassifying lymphoma. Arch Pathol Lab Med 139:245–251CrossRefGoogle Scholar
  53. 53.
    Priola SM, Priola AM, Cataldi A, Fava C (2006) Nodular sclerosing Hodgkin disease presenting as a sternal mass. Br J Haematol 135:594CrossRefGoogle Scholar
  54. 54.
    Kim GR, Hur J, Lee SM et al (2011) CT fluoroscopy-guided lung biopsy versus conventional CT-guided lung biopsy: a prospective controlled study to assess radiation doses and diagnostic performance. Eur Radiol 21:232–239CrossRefGoogle Scholar
  55. 55.
    Prosch H, Stadler A, Schilling M et al (2012) CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: accuracy, complications and radiation dose. Eur J Radiol 81:1029–1033CrossRefGoogle Scholar
  56. 56.
    Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M (2017) Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 27:138–148CrossRefGoogle Scholar
  57. 57.
    Geraghty PR, Kee ST, McFarlane G, Razavi MK, Sze DY, Dake MD (2003) CT-guided transthoracic needle aspiration biopsy of pulmonary nodules: needle size and pneumothorax rate. Radiology 229:475–481CrossRefGoogle Scholar
  58. 58.
    Kuban JD, Tam AL, Huang SY et al (2015) The effect of needle gauge on the risk of pneumothorax and chest tube placement after percutaneous computed tomographic (CT)-guided lung biopsy. Cardiovasc Intervent Radiol 38:1595–1602CrossRefGoogle Scholar

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

Personalised recommendations