Nishigandha Prabhakar Burute MBBS, MD, Abstract Co-Author: Nothing to Disclose

Bhavin Jankharia MD, Presenter: Nothing to Disclose

To report our experience of using a co-axial technique with salinoma formation in CT guided subcarinal lymph node biopsy with an extrapleural approach.

The details of 400 consecutive patients who underwent CT guided subcarinal lymph node biopsy with an extrapleural approach; co-axial technique and salinoma formation, over a period of five years from March 2003 to February 2008 have been reviewed. The lymph nodes were localized with a 64-slice multi-detector CT scanner (Somatom 64, Siemens, Erlangen, Germany). With the patient prone, the pleura were separated from the vertebra with the help of 10 ml injections of saline mixed with lignocaine which resulted in the formation of a salinoma. A 20 gauge co-axial needle was sequentially introduced into the subcarinal node and multiple tissue samples were obtained.  

Technical success; extrapleural access to the lesions was achieved in 397 (99.25%) of 400 cases. In 1 of the remaining cases the needle traversed the lung and in 2, the procedure had to be abandoned due to pain experienced by the patient. Adequate diagnostic samples were achieved in 384 (96%) cases. Diagnoses obtained were; non-caeseating granulomatous disease in 248 (62%), tuberculosis in 61 (15.25%), sarcoidosis in 39 (9.75%), lymphoma in 36 (9%) and metastases in 16 (4%). Immediate complications included pneumothorax seen in 18 (4.5%) patients which were conservatively managed and post procedure pain at the site of needle puncture in 11 (2.75%). No delayed complications were seen.  

Extrapleural technique with saline injection yielded 99.25% technical success and co-axial method helped achieve diagnostic tissue samples in 96% cases. These techniques thus are safe and give a good diagnostic yield with minimal complications and may be incorporated while carrying out biopsies in less accessible lesions such as subcarinal lymph nodes.  

Extrapleural biopsies with salinoma and coaxial technique have high diagnostic yield and minimal complications and should be used especially for less accessible lesions like subcarinal nodes.   

Burute, N, Jankharia, B, Co-Axial Technique and Salinoma Window Formation for CT-guided Subcarinal Lymph Node Biopsy with an Extrapleural Approach: An Experience with 400 Cases.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6013307.html