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Review
. 2024 Oct 11;14(10):1291.
doi: 10.3390/life14101291.

Minimally Invasive Sampling of Mediastinal Lesions

Alberto Fantin  1   2 , Nadia Castaldo  1 , Ernesto Crisafulli  2 , Giulia Sartori  2 , Alice Villa  2 , Elide Felici  2 , Stefano Kette  3 , Filippo Patrucco  4 , Erik H F M van der Heijden  5 , Paolo Vailati  1 , Giuseppe Morana  1 , Vincenzo Patruno  1
Affiliations
Review

Minimally Invasive Sampling of Mediastinal Lesions

Alberto Fantin et al. Life (Basel). .

Abstract

This narrative review examines the existing literature on minimally invasive image-guided sampling techniques of mediastinal lesions gathered from international databases (Medline, PubMed, Scopus, and Google Scholar). Original studies, systematic reviews with meta-analyses, randomized controlled trials, and case reports published between January 2009 and November 2023 were included. Four authors independently conducted the search to minimize bias, removed duplicates, and selected and evaluated the studies. The review focuses on the recent advancements in mediastinal sampling techniques, including EBUS-TBNA, EUS-FNA and FNB, IFB, and nodal cryobiopsy. The review highlights the advantages of an integrated approach using these techniques for diagnosing and staging mediastinal diseases, which, when used competently, significantly increase diagnostic yield and accuracy.

Keywords: EBUS; EUS; TBNA; cryobiopsy; lymph node; mediastinal.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
EBUS-TBNA of a subcarinal lymph node diagnostic for granuloma in a sarcoidosis case. (a) Echocolordoppler assessment via endobronchial ultrasound of the subcarinal lymph node demonstrates a large-caliber vessel’s presence (white arrowhead). (b) Sampling by EBUS-TBNA of the subcarinal lymph node. (c) Chest CT scan of the case under evaluation demonstrating mediastinal adenopathies at both lung hila and in the subcarinal station (white arrowheads). (d) Rapid on-site evaluation of the specimen demonstrating the presence of granulomas. The images are owned by the Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy. Informed consent was obtained from the patients for the publication of the images in an anonymized format.
Figure 2
Figure 2
Primal mediastinal Hodgkin lymphoma. (a) Scout image demonstrating a right pleural effusion associated with mediastinal enlargement. (b) A contrast-enhanced tomographic image shows a large prevascular mediastinal mass with airway compression, heart dislodgement, and right pleural effusion. (c) Ultrasound appearance of the mass and the pleural effusion from a right parasternal view. The images are owned by the Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy. Informed consent was obtained from the patients for the publication of the images in an anonymized format.
Figure 3
Figure 3
Percutaneous sampling with ultrasound guidance. (a) A contrast-enhanced tomographic image shows a large mass with mediastinal infiltration. (b) Tomographic image showing the mass, emphysematous changes in contralateral lung parenchyma and airway deviation. (c) Scout image demonstrates the extent of the mass. (d) Ergonomics of percutaneous sampling with the patient in supine decubitus, one operator’s hand holding the biopsy needle and the other hand holding the ultrasound probe covered with a sterile sheath. (e) Ultrasound appearance of the needle inside the lesion (white arrowheads). (f) Rapid on-site evaluation of the specimen demonstrates a sample with a high proportion of necrotic tissue. The images are owned by the Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy. Informed consent was obtained from the patients for the publication of the images in an anonymized format.
Figure 3
Figure 3
Percutaneous sampling with ultrasound guidance. (a) A contrast-enhanced tomographic image shows a large mass with mediastinal infiltration. (b) Tomographic image showing the mass, emphysematous changes in contralateral lung parenchyma and airway deviation. (c) Scout image demonstrates the extent of the mass. (d) Ergonomics of percutaneous sampling with the patient in supine decubitus, one operator’s hand holding the biopsy needle and the other hand holding the ultrasound probe covered with a sterile sheath. (e) Ultrasound appearance of the needle inside the lesion (white arrowheads). (f) Rapid on-site evaluation of the specimen demonstrates a sample with a high proportion of necrotic tissue. The images are owned by the Department of Pulmonology, S. Maria della Misericordia University Hospital, Udine, Italy. Informed consent was obtained from the patients for the publication of the images in an anonymized format.
See this image and copyright information in PMC

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