Thoracoscopy or CT-Guided Biopsy for Residual Intrathoracic Masses After Treatment of Lymphoma

An intrathoracic mass persists aftercompletion of treatment in 20% of the patients treated for Hodgkin'sdisease (HD) or non-Hodgkin's lymphoma (NHL). Gallium scan andpositron emission tomography allow for diagnosis in most cases. However, in some patients, a pathologic examination of the residualmass (RM) is required. The aim of this study was to evaluate theresults of a thoracoscopic approach for intrathoracic RM, as comparedwith image-guided biopsies. From1996 to 1998, 29 consecutive patients treated for NLH (n = 11) or HD(n = 18) were referred either to radiology (group R; n = 8) or tosurgery (group S; n = 21) for biopsy of an intrathoracic RM. Therewere 13 male and 16 female patients ranging in age from 15 to 56 years(mean, 32 years). The reason for a biopsy was the inability todetermine the nature of the RM by means of radiologic examination orscintigraphy. Biopsy was defined as successful when (1) residuallymphoma was found in the specimen, or (2) benign tissue was found andthe patient remained disease-free after a minimal follow-up period of12 months. A biopsy was defined as a failure when a local recurrenceoccurred in a patient with a diagnosis of benign lesion. No significant procedure-related complicationsoccurred in either group. The mean follow-up was 26 months (range, 13to 72 months). In group R, residual lymphoma was found in only onepatient. In group S, residual lymphoma was found in seven patients(p = 0.5). In the seven patients of group R with a diagnosis ofbenign mediastinal lesion, two patients had a local recurrence and onehad a recurrence within the abdomen. In the 15 patients of group S inwhom no residual disease was found, 1 patient had an intrathoracicrecurrence (p = 0.5) while 2 patients had recurrence in a remotesite. Despite the limited number ofpatients in this series, results suggest that a thoracoscopic approachyields better data than image-guided biopsies.