Diagnostic impact of color Doppler ultrasound-guided core biopsy on fine-needle aspiration of anterior mediastinal masses

Hung-Jen Chen; Wei-Chih Liao; Shinn-Jye Liang; Chia-Hsiang Li; Chih-Yen Tu; Wu-Huei Hsu

doi:10.1016/j.ultrasmedbio.2014.07.012

Diagnostic impact of color Doppler ultrasound-guided core biopsy on fine-needle aspiration of anterior mediastinal masses

Ultrasound Med Biol. 2014 Dec;40(12):2768-76. doi: 10.1016/j.ultrasmedbio.2014.07.012. Epub 2014 Sep 26.

Authors

Hung-Jen Chen¹, Wei-Chih Liao², Shinn-Jye Liang¹, Chia-Hsiang Li², Chih-Yen Tu³, Wu-Huei Hsu⁴

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan.
² Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
³ Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan.
⁴ Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. Electronic address: hsuwh@mail.cmuh.org.tw.

PMID: 25261906
DOI: 10.1016/j.ultrasmedbio.2014.07.012

Abstract

Although lymphoma and thymoma are common etiologies of anterior mediastinal masses (AMMs), smaller percentages and numbers of patients with these diseases have been enrolled in previous ultrasound-guided biopsy studies. To date, there has been no study of color Doppler sonographic features to support the differentiation of AMMs. For this retrospective cohort study, a search of the database of the China Medical University Hospital using the clinical coding "ultrasound-guided biopsy" was conducted for the period December 2003 to February 2013. We selected patients diagnosed with AMMs (not cysts) using radiographic records. This search yielded a list of 80 cases. Real-time ultrasound-guided core needle biopsy (CNB) was performed in all but 5 patients without a sufficient safety range. In 89% (67/75) of these ultrasound-guided CNB cases, the diagnostic accuracy achieved subclassification. Fine-needle aspiration cytology achieved subclassification in only 10% of cases. On color Doppler sonography, 71% of lymphomas were characterized as "rich vascular with central/crisscross collocations" and 29% as "avascular or localized/scattered peripheral vessels." However, decreased proportions of "rich vascular with central/crisscross collocations" were found in lung cancer (4% [1/23], odds ratio = 0.018, 95% confidence interval: 0.002-0.154, p < 0.001) and thymoma/thymic carcinoma (25% [4/16]; odds ratio = 0.133, 95% confidence interval: 0.035-0.514, p = 0.003) compared with the lymphoma group. We conclude that the vessels in lymphoma AMMs have specific patterns on color Doppler sonography. Ultrasound-guided CNB of AMMs had an accuracy of ≤ 89% in diagnosis and subclassification. Fine-needle aspiration cytology itself cannot aid in the diagnosis. Color Doppler sonographic evaluation of AMMs followed by real-time CNB is a more efficient method.

Keywords: Anterior mediastinal mass; Color Doppler ultrasound; Core needle biopsy; Fine-needle aspiration; Vascularization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Endoscopic Ultrasound-Guided Fine Needle Aspiration / methods*
Female
Humans
Image Enhancement / methods*
Male
Mediastinal Neoplasms / diagnostic imaging*
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Ultrasonography, Doppler, Color / methods*
Young Adult