{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:57:30Z","timestamp":1771930650961,"version":"3.50.1"},"reference-count":9,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The pathological diagnosis of mediastinal lesions is crucial for precision oncology. While endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the preferred minimally invasive method for visceral mediastinal lesions, its diagnostic yield can be limited for high-risk lesions surrounded by great vessels. This case demonstrates that under such complex anatomical constraints, a meticulously planned CT-guided percutaneous biopsy serves as a safe and effective alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A middle-aged male patient was highly suspected of having lung cancer with mediastinal metastasis based on clinical and radiological findings. Two successive bronchoscopic biopsies of the pulmonary lesion failed to yield a diagnosis. Although the medical team recommended EBUS-TBNA at a tertiary hospital, the patient opted for a CT-guided biopsy at our institution after considering personal convenience and economic factors. The target was a high-risk mediastinal lymph node located within the vascular \u201ccore area\u201d between the aorta and superior vena cava.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention and outcome<\/jats:title>\n                    <jats:p>Preprocedural planning with contrast-enhanced CT simulated three potential trajectories (transcostochondral, transsternal, transpulmonary). The transsternal approach was prioritized to avoid lung parenchyma, thereby eliminating the risk of pneumothorax\u2014a critical consideration given the patient\u2019s comorbid emphysema and bullae. The initial transcostochondral approach was abandoned due to pain upon vascular contact and restricted maneuverability. The subsequent transsternal approach was successfully performed using a coaxial biopsy system to navigate the narrow vascular space, followed by tract embolization upon needle withdrawal. The procedure was safe, with only minimal, self-resolving mediastinal emphysema. Adequate tissue cores were obtained, enabling a definitive diagnosis of metastatic lung adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For complex mediastinal lesions where standard approaches are unsuitable or declined by the patient, a meticulously planned CT-guided percutaneous biopsy based on three-dimensional anatomical assessment is a feasible and valuable diagnostic strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1755977","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T05:23:23Z","timestamp":1770269003000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: CT-guided biopsy of a mediastinal mass in the visceral compartment"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiangrui","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Oncology, Zigong Third People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Zigong Third People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengluo","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Oncology, Zigong Third People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunwei","family":"Han","sequence":"additional","affiliation":[{"name":"The Department of Oncology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University","place":["Luzhou, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingting","family":"Zhao","sequence":"additional","affiliation":[{"name":"Quality Management Office, Zigong Third People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14176179","article-title":"EBUS-TBNA for diagnosis and staging of lung cancer: A retrospective regional analysis integrating clinical and molecular data (EXPoSURE score)","volume":"14","author":"Andrei","year":"2025","journal-title":"J Clin Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"107389","DOI":"10.1016\/j.rmed.2023.107389","article-title":"Is the diagnostic yield of mediastinal lymph node cryobiopsy (cryoEBUS) better for diagnosing mediastinal node involvement compared to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)? A systematic review","volume":"218","author":"Botana-Rial","year":"2023","journal-title":"Respir Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11122331","article-title":"Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): technical updates and pathological yield","volume":"11","author":"Jaliawala","year":"2021","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11050781","article-title":"Percutaneous CT fluoroscopy-guided core needle biopsy of mediastinal masses: technical outcome and complications of 155 procedures during a 10-year period","volume":"11","author":"Burgard","year":"2021","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2017.10.007","article-title":"CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses","volume":"99","author":"Iguchi","year":"2018","journal-title":"Diagn interventional imaging"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.15.14442","article-title":"Diagnostic yield of CT-guided percutaneous transthoracic needle biopsy for diagnosis of anterior mediastinal masses","volume":"205","author":"Petranovic","year":"2015","journal-title":"AJR Am J roentgenol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-1216","article-title":"Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report","volume":"149","author":"Wahidi","year":"2016","journal-title":"Chest"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.22575\/interventionalradiology.2025-0027","article-title":"Utility of a spring-loaded blunt-tip co-axial needle in accessing \u201cDifficult-to-reach\u201d Targets during percutaneous image-guided procedures","volume":"10","author":"Lam","year":"2025","journal-title":"Interventional Radiol (Higashimatsuyama-shi (Japan)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1653386","article-title":"A gelatin sponge-hemocoagulase sealant for preventing tumor biopsy complications: a dual mechanical and pharmacological barrier","volume":"15","author":"Chen","year":"2025","journal-title":"Front Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1755977\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:56:50Z","timestamp":1771927010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1755977\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":9,"alternative-id":["10.3389\/fonc.2026.1755977"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1755977","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1755977"}}