Objective: To determine the outcome of CT-guided transthoracic mediastinal core-needle biopsy and compare with extrapulmonary access and transpulmonary access.

Study design: Retrospective descriptive study.

Materials and methods: Eighty-nine procedures in 87 patients who underwent CT-guided mediastinal biopsy between January 2003 and December 2006 were reviewed from the procedural records and CT images in Songklanagarind Hospital.

Results: The overall success rate of the CT-guided mediastinal biopsy was 96.6% (86 procedures). The pathology reports showed 65 malignant and 22 benign cases. The overall complication rate was 24.7% (22 procedures). Only three procedures had insufficient tissue for pathologic diagnosis. The complication rate of the transpulmonary access group was 57.6% (19 procedures) with seven pulmonary hemorrhage and 13 pneumothorax (one procedure had both pulmonary hemorrhage and

pneumothorax). The complication rate of the extrapulmonary access group was 5.3% (three procedures) with one pulmonary hemorrhage and two pneumothorax. Five cases of transpulmonary access group had moderate degree of pneumothorax and needed interventional drainage. No mediastinal or chest wall hematoma or death occurred.

Conclusions: The CT-guided transthoracic mediastinal biopsy has a high success rate and is a safe procedure. The extrapulmonary access is a very safe method.