Transcaval core biopsy in malignant superior vena cava obstruction: Potential for single stage diagnosis and treatment

Abstract

Superior vena cava syndrome (SVCS) is secondary to obstruction of venous flow from the superior vena cava to the right atrium. Endovascular stenting is particularly useful when severe or rapidly progressive disease requires urgent treatment. In suspected mediastinal malignancy, transcaval biopsy can be combined with endovenous stenting to provide diagnosis and treatment in a single procedure. Three patients were referred for investigation and treatment of SVCS over a 20 month period. Under fluoroscopic guidance Cook Medical transjugular biopsy sets (with 20-gauge QuickCore biopsy needles) were used and two or three core biopsy samples were obtained. Stents were utilised to treat SVC obstructions in two of three patients. Obtained samples were adequate for histological diagnosis. Diagnoses included small cell and small cell neuroendocrine carcinoma of the lung. No procedural complications were encountered. Importantly, no further invasive diagnostic procedures were required. This is a safe and effective alternative to obtain a histological diagnosis in malignant SVCS and in the appropriate clinical setting biopsy can be combined with SVC stenting in a single procedure.