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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology &#40;FNAC&#41; for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard&#46;</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">CT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions&#46; Helical CT was used with 3&#8211;10mm image thickness range and low radiation dose &#40;40mAs&#44; 120kV&#41;&#46; Samples were immediately examined by a cytologist to determine if they were representative&#46; Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The material was satisfactory for diagnosis in 126 patients &#40;95&#46;2 &#37;&#41;&#44; in whom 103 lesions &#40;78&#46;6&#37;&#41; were considered malignant &#40;62 primary tumours and 41 metastases&#41; and 23 &#40;17&#46;6&#37;&#41; benign&#46; In the 123 patients with clinical monitoring or pathological diagnosis&#44; using FNAC led to the identification of malignancy with a sensitivity of 95&#46;2 &#37; &#40;95&#37;CI&#58; 89&#46;2&#8211;97&#46;9&#37;&#41;&#44; specificity 84&#46;2&#37; &#40;95&#37;CI&#58; 62&#46;4&#8211;94&#46;5&#37;&#41;&#44; positive predictive value 97&#46;1&#37; &#40;95&#37;-CI&#58; 91&#46;7&#8211;99&#46;0&#37;&#41;&#44; negative predictive value 76&#46;2&#37; &#40;95&#37;CI&#58; 54&#46;9&#8211;89&#46;4&#37;&#41;&#44; likelihoodratio positive 6&#46;03 &#40;95&#37;CI&#58; 2&#46;13&#8211;17&#46;05&#41; and accuracy 93&#46;5&#37; &#40;95&#37;CI&#58; 87&#46;7&#8211;96&#46;7&#37;&#41;&#46; Pneumothorax was the most frequent complication &#40;3 cases&#41;&#46; There was good agreement between the cytological findings and the histological findings&#44; not only for malignant lesions &#40;kappa coefficient&#58; 0&#46;641&#41; but also for benign &#40;kappa 0&#46;607&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">CT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses&#44; with a high diagnostic yield for malignancy depicting&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Evaluar la validez diagn&#243;stica de la punci&#243;n aspiraci&#243;n con aguja fina &#40;PAAF&#41; percut&#225;nea en lesiones mediast&#237;nicas considerando la biopsia o el seguimiento cl&#237;nico como patr&#243;n de referencia&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; PAAF percut&#225;nea guiada por TC a 131 pacientes con lesiones mediast&#237;nicas&#46; Se us&#243; un TC helicoidal con cortes de 3&#8211;10 mm y baja dosis de radiaci&#243;n &#40;40 mAs&#44; 120 kV&#41;&#46; Las muestras fueron examinadas in situ por un cit&#243;logo para determinar su validez&#46; Se obtuvo comprobaci&#243;n histol&#243;gica mediante biopsia o estudio de pieza quir&#250;rgica en 73 pacientes y seguimiento cl&#237;nico en 50&#44; compar&#225;ndose los resultados globales y en subgrupos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En 126 pacientes &#40;96&#44;2&#37;&#41; el material fue v&#225;lido para diagn&#243;stico&#46; Ciento tres lesiones &#40;78&#44;6&#37;&#41; fueron consideradas malignas &#40;62 tumores primarios y 41 met&#225;stasis&#41; y 23 &#40;17&#44;6&#37;&#41; benignas&#46; En los 123 pacientes de los que se dispuso de seguimiento cl&#237;nico o patol&#243;gico&#44; la PAAF permiti&#243; identificar malignidad con una sensibilidad del 95&#44;2&#37; &#40;IC95&#37;&#58; 89&#44;2&#8211;97&#44;9&#37;&#41;&#44; especificidad 84&#44;2&#37; &#40;IC95&#37;&#58; 62&#44;4&#8211;94&#44;5&#37;&#41;&#44; valor predictivo positivo 97&#44;1&#37; &#40;IC95&#37;&#58; 91&#44;7&#8211;99&#44;0&#37;&#41;&#44; valor predictivo negativo 76&#44;2&#37; &#40;IC95&#37;&#58; 54&#44;9&#8211;89&#44;4&#37;&#41;&#44; raz&#243;n de verosi- militud positiva 6&#44;03 &#40;IC95&#37;&#58; 2&#44;13&#8211;17&#44;05&#41; y exactitud 93&#44;5&#37; &#40;IC95&#37;&#58; 87&#44;7&#8211;96&#44;7&#37;&#41;&#46; La complicaci&#243;n m&#225;s frecuente fue el neumot&#243;rax &#40;3 casos&#41;&#46; La correlaci&#243;n citohistol&#243;gica fue elevada tanto en las lesiones malignas &#40;kappa 0&#44;641&#41; como en las benignas &#40;kappa 0&#44;607&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La PAAF percut&#225;nea guiada por TC es una t&#233;cnica segura y eficaz para el diagn&#243;stico de masas mediast&#237;nicas con alta rentabilidad para la detecci&#243;n de malignidad&#46;</p>"
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                      "titulo" => "Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions"
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                          "autores" => array:6 [
                            0 => "G&#46; Fern&#225;ndez-Esparrach"
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                            2 => "M&#46; Sol&#233;"
                            3 => "J&#46; Belda"
                            4 => "O&#46; Sendino"
                            5 => "J&#46; Llach"
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                        "paginaFinal" => "346"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15332020"
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                            2 => "I&#46; Vollmer"
                            3 => "L&#46; Pijuan"
                            4 => "A&#46; Gayete"
                            5 => "J&#46; Gea"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Mart&#237;nez-Olondris"
                            1 => "M&#46; Molina-Molina"
                            2 => "A&#46; Xaubet"
                            3 => "R&#46;M&#46; Marrades"
                            4 => "P&#46; Luburich"
                            5 => "J&#46; Ram&#237;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2008"
                        "volumen" => "44"
                        "paginaInicial" => "290"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18559217"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Annessi"
                            1 => "M&#46; Paci"
                            2 => "S&#46; De Franco"
                            3 => "A&#46; Cavazza"
                            4 => "G&#46; Ferrari"
                            5 => "T&#46; Ricchetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chir Ital"
                        "fecha" => "2003"
                        "volumen" => "55"
                        "paginaInicial" => "379"
                        "paginaFinal" => "384"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12872573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of intrathoracic lesions&#58; are sequential fine-needle aspiration &#40;FNA&#41; and core needle biopsy &#40;CNB&#41; combined better than either investigation alone&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Aviram"
                            1 => "J&#46; Greif"
                            2 => "A&#46; Man"
                            3 => "Y&#46; Schwarz"
                            4 => "S&#46; Marmor"
                            5 => "M&#46; Graif"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.crad.2006.11.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "221"
                        "paginaFinal" => "226"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17293214"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Computed tomographyguided biopsy of mediastinal lesions&#58; fine versus cutting needles"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;P&#46; De Farias"
                            1 => "D&#46; Deheinzelin"
                            2 => "R&#46;N&#46; Younes"
                            3 => "R&#46; Chojniak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Hosp Clin Fac Med Sao Paulo"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "69"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12845358"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;W&#46; Assaad"
                            1 => "L&#46; Pantanowitz"
                            2 => "C&#46;N&#46; Otis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/dc.20738"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "705"
                        "paginaFinal" => "709"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17924408"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;G&#46; G&#252;ll&#252;o&#287;lu"
                            1 => "Z&#46; Kili&#231;aslan"
                            2 => "A&#46; Toker"
                            3 => "G&#46; Kalayci"
                            4 => "D&#46; Yilmazbayhan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00423-006-0029-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Langenbecks Arch Surg"
                        "fecha" => "2006"
                        "volumen" => "391"
                        "paginaInicial" => "222"
                        "paginaFinal" => "227"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16534651"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine needle aspiration cytology of anterior mediastinal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Desai"
                            1 => "M&#46; Shah"
                            2 => "S&#46; Patel"
                            3 => "S&#46;N&#46; Shukla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Indian J Pathol Microbiol"
                        "fecha" => "2008"
                        "volumen" => "51"
                        "paginaInicial" => "88"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18417872"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109703006454"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine needle aspiration biopsy in the diagnosis of mediastinal lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Rosenberger"
                            1 => "O&#46; Adler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Roentgenol"
                        "fecha" => "1978"
                        "volumen" => "131"
                        "paginaInicial" => "239"
                        "paginaFinal" => "242"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine-needle aspiration biopsy of mediastinal masses&#58; evaluation of 136 experiences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "O&#46;B&#46; Adler"
                            1 => "A&#46; Rosenberger"
                            2 => "H&#46; Peleg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.140.5.893"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1983"
                        "volumen" => "140"
                        "paginaInicial" => "893"
                        "paginaFinal" => "896"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6601429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Minimally invasive approaches for histological diagnosis of anterior mediastinal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46;T&#46; Fang"
                            1 => "M&#46;Y&#46; Xu"
                            2 => "G&#46; Chen"
                            3 => "Y&#46; Chen"
                            4 => "W&#46;H&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Chin Med J"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "675"
                        "paginaFinal" => "679"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CT-guided transsternal core biopsy of anterior mediastinal masses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;G&#46; Astrom"
                            1 => "K&#46;H&#46; Ahlstrom"
                            2 => "A&#46; Magnusson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.199.2.8668813"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1996"
                        "volumen" => "199"
                        "paginaInicial" => "564"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8668813"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "CT-guided percutaneous needle biopsy of intrathoracic lesions by using the transsternal approach&#58; experience in 37 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Gupta"
                            1 => "M&#46;J&#46; Wallace"
                            2 => "F&#46;A&#46; Morello"
                            3 => "K&#46; Ahrar"
                            4 => "M&#46;E&#46; Hicks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2221010614"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2002"
                        "volumen" => "222"
                        "paginaInicial" => "57"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11756705"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine-needle aspiration of the mediastinum&#58; a clinical&#44; radiologic&#44; cytologic&#44; and histologic study of 42 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;S&#46; Shabb"
                            1 => "M&#46; Fahl"
                            2 => "B&#46; Shabb"
                            3 => "P&#46; Haswani"
                            4 => "G&#46; Zaatari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "1998"
                        "volumen" => "19"
                        "paginaInicial" => "428"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9839132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine-needle aspiration biopsy of the mediastinum&#46; A multiinstitutional analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;N&#46; Powers"
                            1 => "J&#46;F&#46; Silverman"
                            2 => "K&#46;R&#46; Geisinger"
                            3 => "W&#46;J&#46; Frable"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "1996"
                        "volumen" => "105"
                        "paginaInicial" => "168"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8607440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tru-Cut biopsy of mediastinal masses guided by realtime sonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Sawhney"
                            1 => "R&#46; Jain"
                            2 => "M&#46; Berry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Radiol"
                        "fecha" => "1991"
                        "volumen" => "44"
                        "paginaInicial" => "16"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1873945"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinal and gastric EUS&#58; indications and technique of examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; De Luca"
                            1 => "S&#46; Di Bella"
                            2 => "E&#46; D&#8217;Amore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Minerva Med"
                        "fecha" => "2007"
                        "volumen" => "98"
                        "paginaInicial" => "423"
                        "paginaFinal" => "429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17921961"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EUS-guided fine needle aspiration in mediastinal lymphadenopathy of unknown etiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;F&#46; Catalano"
                            1 => "R&#46; Nayar"
                            2 => "F&#46; Gress"
                            3 => "J&#46; Scheiman"
                            4 => "W&#46; Wassef"
                            5 => "M&#46;L&#46; Rosenblatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2002"
                        "volumen" => "55"
                        "paginaInicial" => "863"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12024142"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of benign cysts of the mediastinum&#58; the role and risks of EUS and FNA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "R&#46;S&#46; Hoda"
                            2 => "W&#46; Fickling"
                            3 => "N&#46; Schmulewitz"
                            4 => "S&#46; Varadarajulu"
                            5 => "S&#46;S&#46; Roberts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "362"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14528209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antibiotics are mandatory before EUS-guided FNA in cystic or semisolid lesions of the mediastinum and the pancreas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;A&#46; Eloubeidi"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gie.2005.12.011"
                      "Revista" => array:5 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2006"
                        "volumen" => "63"
                        "paginaInicial" => "890"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16650574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic accuracy and role of immediate interpretation of fine-needle aspiration biopsy specimens from various sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Siverman"
                            1 => "J&#46;L&#46; Finley"
                            2 => "K&#46;F&#46; O&#8217;Brien"
                            3 => "D&#46;J&#46; Dabbs"
                            4 => "H&#46;K&#46; Park"
                            5 => "E&#46;W&#46; Larkin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Cytol"
                        "fecha" => "1989"
                        "volumen" => "33"
                        "paginaInicial" => "791"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2686322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions&#58; a retrospective comparison of diagnostic accuracy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Gong"
                            1 => "N&#46; Sneige"
                            2 => "M&#46; Guo"
                            3 => "M&#46;E&#46; Hicks"
                            4 => "C&#46;A&#46; Moran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Pathol"
                        "fecha" => "2006"
                        "volumen" => "125"
                        "paginaInicial" => "438"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16613349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of malignant thymoma mimicking thyroid carcinoma&#58; a pitfall in fine-needle aspiration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Matsuura"
                            1 => "H&#46; Tokunaga"
                            2 => "T&#46; Miyake"
                            3 => "S&#46; Utsunomiya"
                            4 => "H&#46; Minami"
                            5 => "M&#46; Onji"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr J"
                        "fecha" => "2004"
                        "volumen" => "51"
                        "paginaInicial" => "237"
                        "paginaFinal" => "241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15118276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spindle-cell lesions of the mediastinum&#58; diagnosis by fine-needle aspiration biopsy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;D&#46; Slagel"
                            1 => "C&#46;N&#46; Powers"
                            2 => "M&#46;J&#46; Melaragno"
                            3 => "K&#46;R&#46; Geisinger"
                            4 => "W&#46;J&#46; Frable"
                            5 => "J&#46;F&#46; Silverman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "1997"
                        "volumen" => "17"
                        "paginaInicial" => "167"
                        "paginaFinal" => "176"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9285187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic pitfalls in fine-needle aspiration biopsy of the mediastinum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;K&#46; Singh"
                            1 => "J&#46;F&#46; Silverman"
                            2 => "C&#46;N&#46; Powers"
                            3 => "K&#46;R&#46; Geisinger"
                            4 => "W&#46;J&#46; Frable"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "1997"
                        "volumen" => "17"
                        "paginaInicial" => "121"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9258619"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thymoma mimicking lymphoblastic lymphoma&#58; a pitfall in fine-needle aspiration biopsy interpretation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;D&#46; Friedman"
                            1 => "R&#46;E&#46; Hutchison"
                            2 => "L&#46;J&#46; Coman"
                            3 => "C&#46;N&#46; Powers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/(SICI)1097-0339(199603)14:2<165::AID-DC12>3.0.CO;2-K"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "1996"
                        "volumen" => "14"
                        "paginaInicial" => "165"
                        "paginaFinal" => "171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8964175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differential diagnostic considerations and potential pitfalls in fine-needle aspiration biopsies of the mediastinum"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;R&#46; Geisinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Diagn Cytopathol"
                        "fecha" => "1995"
                        "volumen" => "13"
                        "paginaInicial" => "436"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8834318"
                            "web" => "Medline"
                          ]
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Vol. 46. Issue 5.
Pages 223-229 (May 2010)
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Vol. 46. Issue 5.
Pages 223-229 (May 2010)
Original Article
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Usefulness CT-guided F.N.A.C. in the Diagnosis of Mediastinal Lesions
Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas
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5472
Virginia Pérez Dueñasa,
Corresponding author
virpedue@gmail.com

Corresponding author.
, Isabel Torres Sáncheza, Francisco García Ríob, Emilio Valbuena Durána, Blanca Vicandi Plazac, Jose María Viguer García-Morenoc
a Servicios de Radiología, Hospital Universitario La Paz, Madrid, Spain
b Servicios de Neumología, Hospital Universitario La Paz, Madrid, Spain
c Servicios de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
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Article information
Abstract
Objective

To evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard.

Patients and Methods

CT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3–10mm image thickness range and low radiation dose (40mAs, 120kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50.

Results

The material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2–97.9%), specificity 84.2% (95%CI: 62.4–94.5%), positive predictive value 97.1% (95%-CI: 91.7–99.0%), negative predictive value 76.2% (95%CI: 54.9–89.4%), likelihoodratio positive 6.03 (95%CI: 2.13–17.05) and accuracy 93.5% (95%CI: 87.7–96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607).

Conclusions

CT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting.

Keywords:
Mediastinal lesions
Computed tomography
Fine needle aspiration
Cytology
Sensitivity
Specificity
Resumen
Objetivos

Evaluar la validez diagnóstica de la punción aspiración con aguja fina (PAAF) percutánea en lesiones mediastínicas considerando la biopsia o el seguimiento clínico como patrón de referencia.

Pacientes y métodos

Se realizó PAAF percutánea guiada por TC a 131 pacientes con lesiones mediastínicas. Se usó un TC helicoidal con cortes de 3–10 mm y baja dosis de radiación (40 mAs, 120 kV). Las muestras fueron examinadas in situ por un citólogo para determinar su validez. Se obtuvo comprobación histológica mediante biopsia o estudio de pieza quirúrgica en 73 pacientes y seguimiento clínico en 50, comparándose los resultados globales y en subgrupos.

Resultados

En 126 pacientes (96,2%) el material fue válido para diagnóstico. Ciento tres lesiones (78,6%) fueron consideradas malignas (62 tumores primarios y 41 metástasis) y 23 (17,6%) benignas. En los 123 pacientes de los que se dispuso de seguimiento clínico o patológico, la PAAF permitió identificar malignidad con una sensibilidad del 95,2% (IC95%: 89,2–97,9%), especificidad 84,2% (IC95%: 62,4–94,5%), valor predictivo positivo 97,1% (IC95%: 91,7–99,0%), valor predictivo negativo 76,2% (IC95%: 54,9–89,4%), razón de verosi- militud positiva 6,03 (IC95%: 2,13–17,05) y exactitud 93,5% (IC95%: 87,7–96,7%). La complicación más frecuente fue el neumotórax (3 casos). La correlación citohistológica fue elevada tanto en las lesiones malignas (kappa 0,641) como en las benignas (kappa 0,607).

Conclusiones

La PAAF percutánea guiada por TC es una técnica segura y eficaz para el diagnóstico de masas mediastínicas con alta rentabilidad para la detección de malignidad.

Palabras clave:
Lesiones mediastínicas
Tomografía computerizada
Punción aspiración con aguja fina
Citología
Sensibilidad
Especificidad
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References
[1.]
G. Fernández-Esparrach, M. Pellisé, M. Solé, J. Belda, O. Sendino, J. Llach, et al.
Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions.
Arch Bronconeumol, 43 (2007), pp. 219-224
[2.]
T.J. Savides, A. Perricone.
Impact of EUS-guided FNA of enlarged mediastinal lymph nodes on subsequent thoracic surgery rates.
Gastrointest Endosc, 60 (2004), pp. 340-346
[3.]
A. Sánchez-Font, V. Curull, I. Vollmer, L. Pijuan, A. Gayete, J. Gea.
Utilidad de la punción aspirativa transbronquial guiada con ultrasonografía endobronquial (USEB) radial para el diagnóstico de adenopatías mediastínicas.
Arch Bronconeumol, 45 (2009), pp. 212-217
[4.]
I. Garcia-Olivé, E.X. Valverde Forcada, F. Andreo García, J. Sanz-Santos, E. Castellà, M. Llatjós, et al.
La ultrasonografía endobronquial lineal como instrumento de diagnóstico inicial en el paciente con ocupación mediastínica.
Arch Bronconeumol, 45 (2009), pp. 266-270
[5.]
P. Martínez-Olondris, M. Molina-Molina, A. Xaubet, R.M. Marrades, P. Luburich, J. Ramírez, et al.
Punción transbronquial aspirativa en el estudio de las adenopatías mediastínicas: rentabilidad y coste-beneficio.
Arch Bronconeumol, 44 (2008), pp. 290-294
[6.]
V. Annessi, M. Paci, S. De Franco, A. Cavazza, G. Ferrari, T. Ricchetti, et al.
Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy.
Chir Ital, 55 (2003), pp. 379-384
[7.]
G. Aviram, J. Greif, A. Man, Y. Schwarz, S. Marmor, M. Graif, et al.
Diagnosis of intrathoracic lesions: are sequential fine-needle aspiration (FNA) and core needle biopsy (CNB) combined better than either investigation alone?.
Clin Radiol, 62 (2007), pp. 221-226
[8.]
A.P. De Farias, D. Deheinzelin, R.N. Younes, R. Chojniak.
Computed tomographyguided biopsy of mediastinal lesions: fine versus cutting needles.
Rev Hosp Clin Fac Med Sao Paulo, 58 (2003), pp. 69-74
[9.]
M.W. Assaad, L. Pantanowitz, C.N. Otis.
Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum.
Diagn Cytopathol, 35 (2007), pp. 705-709
[10.]
M.G. Güllüoğlu, Z. Kiliçaslan, A. Toker, G. Kalayci, D. Yilmazbayhan.
The diagnostic value of image guided percutaneous fine needle aspiration biopsy in equivocal mediastinal masses.
Langenbecks Arch Surg, 391 (2006), pp. 222-227
[11.]
F. Desai, M. Shah, S. Patel, S.N. Shukla.
Fine needle aspiration cytology of anterior mediastinal masses.
Indian J Pathol Microbiol, 51 (2008), pp. 88-90
[12.]
A. Rosenberger, O. Adler.
Fine needle aspiration biopsy in the diagnosis of mediastinal lesions.
Am J Roentgenol, 131 (1978), pp. 239-242
[13.]
O.B. Adler, A. Rosenberger, H. Peleg.
Fine-needle aspiration biopsy of mediastinal masses: evaluation of 136 experiences.
AJR Am J Roentgenol, 140 (1983), pp. 893-896
[14.]
W.T. Fang, M.Y. Xu, G. Chen, Y. Chen, W.H. Chen.
Minimally invasive approaches for histological diagnosis of anterior mediastinal masses.
Chin Med J, 20 (2007), pp. 675-679
[15.]
K.G. Astrom, K.H. Ahlstrom, A. Magnusson.
CT-guided transsternal core biopsy of anterior mediastinal masses.
Radiology, 199 (1996), pp. 564-567
[16.]
S. Gupta, M.J. Wallace, F.A. Morello, K. Ahrar, M.E. Hicks.
CT-guided percutaneous needle biopsy of intrathoracic lesions by using the transsternal approach: experience in 37 patients.
Radiology, 222 (2002), pp. 57-62
[17.]
N.S. Shabb, M. Fahl, B. Shabb, P. Haswani, G. Zaatari.
Fine-needle aspiration of the mediastinum: a clinical, radiologic, cytologic, and histologic study of 42 cases.
Diagn Cytopathol, 19 (1998), pp. 428-436
[18.]
C.N. Powers, J.F. Silverman, K.R. Geisinger, W.J. Frable.
Fine-needle aspiration biopsy of the mediastinum. A multiinstitutional analysis.
Am J Clin Pathol, 105 (1996), pp. 168-173
[19.]
S. Sawhney, R. Jain, M. Berry.
Tru-Cut biopsy of mediastinal masses guided by realtime sonography.
Clin Radiol, 44 (1991), pp. 16-19
[20.]
L. De Luca, S. Di Bella, E. D’Amore.
Mediastinal and gastric EUS: indications and technique of examination.
Minerva Med, 98 (2007), pp. 423-429
[21.]
M.F. Catalano, R. Nayar, F. Gress, J. Scheiman, W. Wassef, M.L. Rosenblatt, et al.
EUS-guided fine needle aspiration in mediastinal lymphadenopathy of unknown etiology.
Gastrointest Endosc, 55 (2002), pp. 863-869
[22.]
S.M. Wildi, R.S. Hoda, W. Fickling, N. Schmulewitz, S. Varadarajulu, S.S. Roberts, et al.
Diagnosis of benign cysts of the mediastinum: the role and risks of EUS and FNA.
Gastrointest Endosc, 58 (2003), pp. 362-368
[23.]
M.A. Eloubeidi.
Antibiotics are mandatory before EUS-guided FNA in cystic or semisolid lesions of the mediastinum and the pancreas.
Gastrointest Endosc, 63 (2006), pp. 890
[24.]
J.F. Siverman, J.L. Finley, K.F. O’Brien, D.J. Dabbs, H.K. Park, E.W. Larkin, et al.
Diagnostic accuracy and role of immediate interpretation of fine-needle aspiration biopsy specimens from various sites.
Acta Cytol, 33 (1989), pp. 791-796
[25.]
Y. Gong, N. Sneige, M. Guo, M.E. Hicks, C.A. Moran.
Transthoracic fine-needle aspiration vs concurrent core needle biopsy in diagnosis of intrathoracic lesions: a retrospective comparison of diagnostic accuracy.
Am J Clin Pathol, 125 (2006), pp. 438-444
[26.]
B. Matsuura, H. Tokunaga, T. Miyake, S. Utsunomiya, H. Minami, M. Onji.
A case of malignant thymoma mimicking thyroid carcinoma: a pitfall in fine-needle aspiration.
Endocr J, 51 (2004), pp. 237-241
[27.]
D.D. Slagel, C.N. Powers, M.J. Melaragno, K.R. Geisinger, W.J. Frable, J.F. Silverman.
Spindle-cell lesions of the mediastinum: diagnosis by fine-needle aspiration biopsy.
Diagn Cytopathol, 17 (1997), pp. 167-176
[28.]
H.K. Singh, J.F. Silverman, C.N. Powers, K.R. Geisinger, W.J. Frable.
Diagnostic pitfalls in fine-needle aspiration biopsy of the mediastinum.
Diagn Cytopathol, 17 (1997), pp. 121-126
[29.]
H.D. Friedman, R.E. Hutchison, L.J. Coman, C.N. Powers.
Thymoma mimicking lymphoblastic lymphoma: a pitfall in fine-needle aspiration biopsy interpretation.
[30.]
K.R. Geisinger.
Differential diagnostic considerations and potential pitfalls in fine-needle aspiration biopsies of the mediastinum.
Diagn Cytopathol, 13 (1995), pp. 436-442
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