Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses

Figure 2

Twenty-nine-year-old man with thymoma. (a) Plain computed tomography revealed an irregular mass in the right anterior mediastinum. Contrast-enhanced computed tomography revealed that the mass was compressing the superior vena cava and aorta. (b) B-mode ultrasound showed an inhomogeneous mass visible in the right anterior mediastinum. Color Doppler ultrasound showed dot-like flow signals in the center of mass. (c) US-CNB of the mass with prebiopsy conventional US evaluation. White triangles indicate the needle. (d) H&E staining (magnification 100x) of the core needle biopsy sample showed major necrosis and a small number of enlarged nuclear cells with a nest-like arrangement, suspected tumor, and an insufficiency for immunohistochemistry staining. (e) Contrast-enhanced ultrasound revealed intensive inhomogeneous enhancement of the left anterior part of the AMM (22 seconds after the injection of 2.4 ml SonoVue); the left posterior part of the AMM was not enhanced throughout. The white flower-shaped dot indicates the necrosis with great confidence. (f) US-CNB of the mass with prebiopsy contrast-enhanced ultrasound targeted the left anterior enhanced portion of the AMM, which was confirmed by CEUS. (g) H&E staining (magnification 100x) of the core needle biopsy sample revealed karyomegaly within lymphocytes and a diagnosis of thymoma B1 with immunohistochemical staining, which was confirmed by surgical pathology. The approach of all ultrasonography procedures involved a right parasternal scan of the 3rd intercostal space.

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