Magnetic resonance imaging-guided percutaneous biopsy of mediastinal masses: diagnostic performance and safety.

OBJECTIVE: The objective of this study was to evaluate the diagnostic performance and safety of magnetic resonance (MR) imaging-guided percutaneous mediastinal biopsy procedures using a 0.23-T open MR system with optical tracking navigation.

MATERIALS AND METHODS: A retrospective analysis of 59 participants (38 males and 21 females; mean age, 45 years; range, 16-73 years) who underwent MR imaging-guided percutaneous mediastinal biopsy procedures was performed. The access techniques included extrapleural (40 of 59; 67.8%) and transpulmonary (19 of 59; 32.2%) needle paths. Tissue sampling techniques included fine-needle aspiration (22 of 59; 37.3%) and core-needle biopsy (37 of 59; 62.7%). Histopathological analysis of surgical specimen and clinical and imaging follow-ups were used as the reference standard. The procedures were evaluated for technical success rate, number of biopsy passes, diagnostic performance, procedure time, and complications.

RESULTS: Technical success was achieved in 57 of the 59 procedures (96.6%). For the fine-needle aspiration, a mean of 3 passes (range, 2-4 passes) was performed. For the core-needle biopsy, a mean of 4 passes (range, 3-6 passes) was performed. Pathological and cytological analysis of biopsy specimens showed 41 of 57 malignant lesions (71.9%) and 16 of 57 benign lesions (28.1%), with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 93.2% (41 of 44), 100% (13 of 13), 100% (41 of 41), 81.2% (13 of 16), and 94.7% (54 of 57), respectively. Procedure time was 30 minutes (range, 20-50 minutes). Mild hemoptysis occurred in 3 cases, and in 2 cases, a small pneumothorax occurred.

CONCLUSIONS: Magnetic resonance imaging-guided biopsy of mediastinal masses has a high diagnostic performance and is safe for use in clinical practice.