Anterior mediastinal masses — A multidisciplinary pathway for safe diagnostic procedures
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In brief
In brief
Retrospective study of 44 pediatric patients with anterior mediastinal masses demonstrates that safe tissue diagnosis can be achieved through personalized multidisciplinary approach. By utilizing alternative tissue sources, local anesthesia, and ketamine sedation with spontaneous breathing, the team minimized general anesthesia risks with no major complications.
Written by the GCMD Library team from the article.
Objective
The objective of this study was to report our multidisciplinary diagnostic approach for patients with anterior mediastinal masses (AMM).
Methods
A retrospective review of patients with AMM at a tertiary pediatric surgical oncology centre (January 2011–December 2016) was performed. We analyzed data on clinical presentation, mode of tissue diagnosis, anesthetic techniques, and complications.
Results
Of the 44 patients admitted with AMM (median age 11 years, 27 males and 17 females), 22 had respiratory symptoms. Imaging revealed tracheobronchial compression in 26 children. Twenty patients had a lymph node biopsy. Ten patients had image-guided core biopsy of the mediastinal mass, and 2 had mediastinoscopic biopsy of a paratracheal lymph node. One patient with likely recurrence of a relapsed metastatic ethmoid carcinoma did not have a biopsy. The diagnosis was made from alternative tissues, such as pleural fluid in 4 and peripheral blood in 7 patients. Twenty-five anesthetics were assessed, as 14 patients required no or only local anesthesia, and 5 had unavailable anesthetic notes. Eighteen of 25 patients were anesthetized maintaining spontaneous breathing, mostly by means of ketamine sedation. There were no major anesthetic complications.
Conclusion
Safe tissue diagnosis of anterior mediastinal masses can be obtained by a personalized multidisciplinary approach. Use of alternative tissues, local anesthesia, and ketamine sedation help minimize the need for general anesthesia, muscle paralysis, and controlled ventilation.
Level of evidence
IV (Case Series with no Comparison Group).