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Diagnostic yield and safety of ultrasound-assisted biopsies in superior vena cava syndrome

¹ Division of Pulmonology, Dept of Medicine, ³ Division of Medical Physiology, Dept of Biomedical Sciences, University of Stellenbosch and Tygerberg Academic Hospital, and ² Division of Anatomical Pathology, Dept of Pathology, University of Stellenbosch and National Health Laboratory Services, Cape Town, South Africa.

CORRESPONDENCE: C. F. N. Koegelenberg, Division of Pulmonology, Dept of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa. Fax: 27 21933 3591. E-mail: coeniefn{at}sun.ac.za

Keywords: Bronchogenic carcinoma, cutting needle biopsy, superior vena cava syndrome, transthoracic fine needle aspiration, ultrasound

Received: August 20, 2008
Accepted December 17, 2008

The yield and safety of ultrasound (US)-assisted transthoracic fine needle aspirations (TTFNA) and cutting needle biopsies (CNB) in the setting of superior vena cava (SVC) syndrome are unknown. The aims of the present prospective study were to asses the diagnostic yield and safety of US-assisted TTFNA and CNB in SVC syndrome with an associated mass lesion abutting the chest wall.

Over a 3-yr period, the present authors screened 59 patients with SVC syndrome, and enrolled 25 patients who had an associated mass lesion that extended to the chest wall. US-assisted TTFNA with rapid on-site evaluation (ROSE) was performed in all cases. CNBs were performed where a provisional diagnosis of bronchogenic carcinoma could not be established, and in 57.1% of patients with bronchogenic carcinoma (limited due to safety constraints).

ROSE of US-assisted TTFNA confirmed diagnostically useful material in 24 patients, and cytological diagnoses were ultimately made in all of these cases (diagnostic yield 96%). US-assisted CNB had a diagnostic yield of 87.5%. Minor haemorrhage occurred in one out of 25 TTFNA and three out of 16 CNB. Neither procedure resulted in major haemorrhage nor pneumothoraces.

US-assisted TTFNA and CNB have a high diagnostic yield and are safe in the setting of SVC syndrome with an associated mass lesion abutting the chest wall.