Transesophageal endosonographically-guided fine needle aspiration biopsy of mediastinal space-occupying lesions of uncertain importance

Endoscope-guided fine-needle biopsy of mediastinal space-occupying lesions is a recently introduced method of low invasiveness. This is a report of the authors' experience. Between Nov. 1996 and April 1999 endoscope-guided mediastinal biopsies (Pentax FG 32 UA) were performed in 31 patients (eight women, 23 men; aged 27-80 years). The space-occupying lesion had to be less than 1 cm from the oesophagus and not more easily approachable in other ways. The method was successful in 23 of the 31 patients (74%). In ten of the 31 patients (32%) a malignant lesion was histologically proven. In six patients (19%) sarcoidosis was revealed. Of the eight patients with inadequate biopsy material a malignancy was ultimately diagnosed in three, sarcoidosis in one (in three by mediastinoscopy, in one by laparoscopy). Thus the sensitivity of diagnosing a malignancy was 77%, with a specificity of 100%. Follow-up examinations in the remaining four patients excluded a malignancy. Endoscope-guided fine-needle biopsy of mediastinal space-occupying lesions is a technically simple method causing little stress to the patient that can frequently elucidate the lesion's benignity or malignancy. Invasive procedures, such as mediastinoscopy, may thus be avoided in some patients.