Wahid Hussein Tantawy MD, Presenter: Nothing to Disclose

Emad Hamza El-Gemeie MD, Abstract Co-Author: Nothing to Disclose

To report our experience with CT-guided extrapleural paravertebral subcarinal lymph biopsy using a 25 guage thin needle without the need for injection of saline to artificially widen the mediastinum.

The biopsy was performed using a 25 guage needle; which was advanced lateral to the vertebral body between endothoracic fascia and the parietal pleural to gain access to the subcarinal lymph nodes. 121 patients were included in the study (79 males, 42 females; age range, 6 – 76 years). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist, and the sensitivity and specificity rates were calculated, complications were documented for each case especially pneumothorax and haemorrhage.

A cytopathological diagnosis was reached in all cases; The procedure was performed for one time in 81 cases (66.9%) and repeated twice in 36 cases (29.8%) and for three times in 4 cases (3.3%). All reaspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. A primary cytopathological diagnosis was reached in all cases. Immunophenotyping study was done in 86 cases to document the primary diagnosis and to classify the malignant lesions; No pneumothorax encountered and a small amount of haematoma was noted in 4 cases (3.3%).

FNAC using a 25 guage needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT-guided approach without a need for artificial widening of the mediastinum by saline injection is a safe minimally invasive tolerable procedure yielding a high sensitivity and specificity rates in the presence of an experienced cytopathologist attending the procedure.

Extra pleural paravertebral C.T guided biopsy of the subcarinal lymph nodes using 25 guage needle can yield high rates of diagnostic sensitivity and specificity with very low complication rate.

Tantawy, W, El-Gemeie, E, Extrapleural Paravertebral CT-guided Biopsy of Subcarinal Lymph Nodes.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8001739.html