Percutaneous needle aspiration of hilar and mediastinal masses.

Needle aspiration biopsy of hilar and mediastinal masses was attempted in 100 patients and completed in 91. There were no major complications. In the group with completed biopsies, there were 83 patients with malignant neoplasms; a positive diagnosis of malignancy was established in 80 (96%). Two of the three false-negative results occurred in patients with Hodgkin disease. In all 8 patients with benign masses, the biopsy results were correct. Five of the nine incomplete biopsies occurred in patients with aortic aneurysms that simulated lung or mediastinal masses. In the other 4 patients, the needle biopsy was not completed for technical reasons. Needle biopsy can be performed in practically all areas of the mediastinum, does not require general anesthesia or hospitalization, and is well tolerated by the patient. In this series, the use of mediastinal needle biopsy made it possible to avoid surgery and mediastinoscopy in 72 patients with unresectable malignant neoplasms and 5 patients with innocuous benign mediastinal masses. Needle biopsy may be the preferred initial procedure to obtain a tissue diagnosis in patients with mediastinal masses.