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

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

	Abstract

The yield and safety of 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 this 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 three-year period we screened 59 patients with SVC syndrome, and enrolled 25 patients who had an associated mass lesion. 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 1/25 TTFNA and 3/16 CNB. Neither procedure resulted in major haemorrhage or 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.