Publication:

Radiological evaluation and computed tomography-guided biopsy of pulmonary and mediastinal masses: a prospective study with histopathological correlation

Background Pulmonary and mediastinal masses constitute a significant diagnostic challenge in clinical practice. Computed tomography (CT) is the cornerstone of radiological assessment, while CT-guided biopsy serves as the gold standard for definitive tissue characterization. Objectives of the study was to evaluate CT as an imaging modality and to assess the diagnostic accuracy and safety profile of CT-guided biopsy in pulmonary and mediastinal masses, using histopathology as the reference standard.

Methods This prospective observational study enrolled 35 patients aged ≥18 years with pulmonary or mediastinal masses referred for CT-guided biopsy at the Department of Radiodiagnosis, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, from January 2023 to June 2024. CT features including lesion site, margins, enhancement pattern, and associated findings were documented. Tissue samples were correlated with histopathological diagnosis.

Results Patients were predominantly male (54.3%) and aged above 60 years (60.0%). Pulmonary lesions predominated (91.4%). CT categorized 85.7% of lesions as malignant; histopathology confirmed malignancy in 77.1%, with adenocarcinoma being the most frequent diagnosis (37.1%). The CT–histopathology correlation rate was 88.6%. CT demonstrated sensitivity of 96.3%, specificity of 50.0%, positive predictive value of 86.7%, and negative predictive value of 80.0%. Biopsy adequacy was 94.3%. Complications were limited to mild pneumothorax in 14.3%; no major adverse events occurred.

Conclusion CT is a highly sensitive modality for evaluating thoracic masses, and CT-guided biopsy is safe with high diagnostic adequacy. The strong radiological–pathological concordance supports an integrated multidisciplinary approach in managing pulmonary and mediastinal masses.