CT-assisted fluoroscopically guided aspiration biopsy of central hilar and mediastinal masses.

A protocol designed to overcome the inherent limitations of fluoroscopically guided thin-needle aspiration biopsy of central hilar and mediastinal lesions, involving addition of computed tomography to classical plain radiography and tomography, was applied prospectively for 24 months. The same protocol was applied to all referred patients regardless of the compartmental location of the lesion. Experience to date with 17 patients has yielded extremely accurate results. Representative tissue was obtained in each case, and all 11 malignant lesions were distinguished from the 6 benign ones. A lesion smaller than 1.5 cm, not visible on the lateral chest radiograph, was successfully sampled. A variety of malignant mediastinal tumors were diagnosed, as well as tuberculosis and cryptococcosis.