Abstract

Mediastinal lesions are extremely rare and being recognized as notoriously silent, are often considered indolent. Methods: A five-year retrospective observational study was undertaken on 55 patients with mediastinal lesion who had undergone image-guided fine-needle aspiration cytology (FNAC). Cyto-histopathological correlation was feasible in 31 patients. All clinical, radiological and pathological details were retrieved from institutional records for retrospective analysis. Results: Of 55 cases, 11% (n=6) smears were non-diagnostic or inadequate/ inconclusive, 4% (n=2) inflammatory, 9% (n=5) benign, 2% (n=1) atypical, 16% (n=9) suspicious for malignancy and 58% (n=32) malignant. Most patients were in 5th-6th decades of life with male: female ratio 2:1 (37 males, 18 females). Maximum 87.3%mediastinal lesions were localized in anterior mediastinum. Non-Hodgkin lymphoma (NHL) (n=11, 22%) followed by metastatic carcinoma (n=9, 18%) constituted most common mediastinal lesions. Commonest malignancy observed during first four decades of life was NHL. Metastatic carcinoma predominated in 6th-7th decades. Sensitivity, specificity and diagnostic accuracy obtained were 93%, 67% and 90.32% respectively. Conclusions: The study highlights that FNA is a minimally invasive invaluable tool to help characterize mediastinal lesions and further guide clinical management. A changing trend of spectrum of anterior mediastinal lesions is noted, with NHL and metastatic carcinoma being more common as opposed to previously described thymoma. This reaffirms the necessity for a meticulous clinical, radiological and pathological evaluation of mediastinal lesions, to rule out the possibility of malignancy in mediastinum, where malignant lesions now predominate. Knowledge of age-wise distribution facilitates to narrow down differential diagnoses

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