Investigation of the risks of general anesthesia or sedation for mediastinal tumor tissue sampling and our trial of tumor needle biopsy under local anesthesia

Abstract

In pediatric patients with mediastinal tumors (MTs), tissue sampling under general anesthesia (GA) is often considered for diagnosis. However, GA for these patients carries the risk of respiratory circulatory failure due to airway narrowing and other causes. The aim of this study was to examine the risks of these situations and to evaluate the effectiveness of MT needle biopsy as a local anesthetic biopsy option. Patients who were diagnosed with MT and had tissue sampling performed at our hospital between 2012 and 2021 were included in this study. Patients diagnosed on the basis of the results of a peripheral blood test and bone marrow examination were excluded. The medical records were reviewed retrospectively. Twenty-one patients were enrolled, with a median age at biopsy of 6 years. Airway symptoms were present in 13 patients, and orthopnea was observed in two patients. Three patients had superior vena cava syndrome and three had pericardial effusion. The median mediastinal mass ratio was 48, the median % cross-sectional area was 75.7, and the Blank risk classification was high risk in eight patients, intermediate risk in nine patients, and low risk in four patients. The diagnoses were lymphoma, neuroblastoma, germ cell tumor, and others. Tissue sampling under GA was performed on 13 patients, and all patients were diagnosed, with one complication. Local anesthesia (LA) was used for tissue sampling in eight patients, and all patients were diagnosed and none had complications. LA is recommended for MT with high risks of adverse effects of GA. Needle biopsy of MT under LA is safe and effective.