J Korean Radiol Soc.  1995 Sep;33(3):379-382.

Transthoracic Fine Needle Aspiration Biopsy of Subcarinal Lesion: Oblique Approach Using Biplane Fluoroscopic Guidance

• Choi YW
• Kim ST
• Seo HS
• Jeon SC
• Hahm CK

Abstract

PURPOSE
To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy.
MATERIALS AND METHODS
Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus.
RESULTS
Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2.
CONCLUSION
Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.

MeSH Terms

Adenocarcinoma
Biopsy*
Biopsy, Fine-Needle*
Bronchi
Carcinoma, Adenosquamous
Carcinoma, Small Cell
Carcinoma, Squamous Cell
Chest Tubes
Diagnosis
Drainage
Hemoptysis
Humans
Lymph Nodes
Needles
Neoplasm Metastasis
Pneumothorax
Spine
Thorax
Tomography, X-Ray Computed
X-Ray Film