Shaheen MZ†, Sardar K†, Murtaza HG†, Safdar SS†, Hafeez A†, Mushtaq MA†, Hussain M†, Shahzad I†, Pervaiz A‡, Aslam M‡.

†Department of Pulmonology, Nishtar Hospital Multan.
‡Department of Radiology, Nishtar Hospital Multan

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ABSTRACT

INTRODUCTION:

Mediastinal and hilar mass lesions pose diagnostic problems due to their location and difficult access. Centrally located masses are not visible on routine ultrasound. There are limited facilities for mediastinoscopy and the availability of interventional radiologist in most teaching and district hospitals in Pakistan.  Presence of complex vascular structures in the Mediastinal and hilar areas demand precise location and route for needle aspiration cytology and biopsies (FNAC & FNAB). Computerized tomography (CT) has made it possible to better identify masses, determine their relationship to major vessels and plan the optimal approach.

METHOD: A total of 159 patients underwent CT guided FNAC & FNAB during 2003 and 2005. All patients presented with hilar or mediastinal mass lesions on chest X-rays and were referred for establishing the diagnosis. There was no evidence for distant metastasis and bronchoscopy was unremarkable.  The lesions were localized with a CT scan and the approach and distance determined by using the grid scale. Aspiration and biopsy needles were passed after application of local anesthesia and position confirmed via limited CT cuts before obtaining the tissue samples.

RESULTS: There were 159 patients, of them 104 were male and mean age was 52 years (range 39–76). Anatomical distribution of lesions was: hilar 46; anterior mediastinum 45; middle 28; and posterior 40. Histological diagnosis was confirmed in 143 patients, which was: adenocarcinoma 44; squamous cell carcinoma 41; small cell carcinoma 13; non Hodgkin’s lymphoma 5; Hodgkin’s disease 2; metastatic carcinoma 28; tuberculosis 8; and Thymoma 2. Among complications experienced, there was local pain in 25, mild haemoptysis in 14, large haemoptysis in 3, small pneumothorax in 31, large pneumothorax in 8 (6 patient required a small bore chest catheter for the drainage of pneumothorax). There was no death related to the procedure.  

CONCLUSION: CT guided FNAC and FNAB of mediastinal and hilar masses is a safe, accurate and well tolerated method. It is a speedy and cost effective method as compared to mediastinoscopy. In the absence of an interventional radiologist, this procedure can be done safely by the pulmonologists with low rates of acceptable complications.

Key:  FNAC – Fine needle aspiration cytology.  FNAB- Fine needle aspiration biopsy.