Diagnostic strategies for mediastinal tumors and cysts.

Many histologically different tumors and cysts that affect people of all ages arise from the multiple anatomic structures present in the mediastinum. The number of diagnostic possibilities can be narrowed by considering the patient's age, tumor location, the presence or absence of symptoms and signs, the association of a specific systemic disease, radiographic findings, and biochemical markers. Pathologic diagnosis is often required to confirm a presumed diagnosis and to select the optimal treatment modality. A variety of biopsy techniques for obtaining tissue from the mediastinum have been described, including ultrasound-guided endoscopic biopsy, percutaneous image-guided needle biopsy, parasternal anterior mediastinotomy, cervical mediastinoscopy, and video-assisted thoracoscopic surgery. The choice of biopsy technique depends on the localization of the lesion, clinical factors such as the age and the condition of the patient, and the availability of special techniques with the required expert and the equipment.