Anterior Mediastinotomy: Is it Still a Reliable Diagnostic Method in the Era of Minimally Invasive Techniques? – A Retrospective Analysis of 73 Cases
Abstract
Background: Rapid diagnosis of anterior mediastinal masses, which can arise from a wide range of diseases, is crucial for adopting appropriate treatment approaches.
Methods: The demographic, radiological, operative, and pathological data of 73 patients who underwent diagnostic procedures—computed tomography (CT)-guided transthoracic fine-needle aspiration biopsy (TTFNAB), anterior mediastinotomy (AM), or video-assisted thoracoscopic surgery (VATS)—for anterior mediastinal masses between 2013 and 2023 were retrospectively analyzed.
Results: The mean age of the patients was 45.29±18.51 years (range: 9–82), and 40 (54.8%) were male. The most common presenting symptom was chest pain (33%), while incidental detection occurred in 23.3% of cases. Initial biopsy procedures yielded a pathological diagnosis in 90.4% of cases, with lymphoma being the most common diagnosis (42.4%). Compared to surgical biopsies, TTFNAB had significantly lower diagnostic yield and shorter hospital stay but was performed in significantly older patients (p=0.025, p<0.001, p<0.001, respectively). Patients who underwent VATS had significantly smaller tumor sizes compared to other procedures (6.25cm, p=0.004). No significant differences were found among the groups in terms of complications, SUVmax values, sex distribution, or tumor laterality. AM and VATS demonstrated similar outcomes except for tumor size. The overall mean hospital stay was 2.59±2.03 days, and no procedure-related mortality was observed.
Conclusion: Surgical biopsies provide a higher diagnostic yield than needle biopsies for anterior mediastinal masses. Despite a decline in its use in recent years, AM remains a viable option alongside VATS, particularly for diagnosing larger anterior mediastinal masses, given their comparable diagnostic accuracy and morbidity rates.
Keywords
anterior mediastinal mass , anterior mediastinotomy , lymphoma
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