Fine needle aspiration biopsy of mediastinal and peripheral pulmonary masses guided by real-time sonography.

The value of fine needle aspiration biopsy guided by real-time ultrasonography was assessed in 45 patients referred with an intrathoracic mass adjacent to the chest wall. The mass, as determined by chest x-ray examination, was visualized sonographically and subsequently biopsied in 42 patients. Puncture specimen was diagnostic in 34 patients (81 percent), including nine of 12 patients (75 percent) with previous failure of biopsy under fluoroscopic guidance. The success rate was similar in pulmonary and mediastinal masses, 18 of 23 and 16 of 19 patients, respectively. A diagnostic biopsy was obtained in 26 of 31 patients with a malignant mass. No complications were observed except for a minimal pneumothorax in one patient. Thus, real-time sonographic guidance is a safe, easy, and reliable method in biopsy of pulmonary and mediastinal masses adjacent to the chest wall and may also succeed in patients where fluoroscopically guided biopsy has failed.