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Ann Thorac Surg. 2011 Apr;91(4):1066-71. doi: 10.1016/j.athoracsur.2010.12.032.

Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients.

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1
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. mi@thoracic.med.osakau.ac.jp

Abstract

BACKGROUND:

A computed tomographic-guided percutaneous needle biopsy (CTGNB) is useful as an option for pathologic diagnosis of lung cancer, especially in patients with peripheral small-sized nodules. We aimed to assess the risk of pleural seeding of cancer cells, leading to postoperative relapse with dissemination caused by the procedure.

METHODS:

We investigated the clinical outcomes of 447 stage I lung cancer patients. Survival analysis was performed using the Kaplan-Meier method and a log-rank test. Pleural recurrence rates were also determined. Furthermore, propensity score matching analysis was used to reduce background bias from patient characteristics.

RESULTS:

The 5-year, disease-free survival rate was 89.1% in patients diagnosed with CTGNB, and 85.5% in those diagnosed using a transbronchial biopsy or open lung biopsy procedure. Local recurrence with pleural dissemination was found in 8 of 13 recurrence cases (61.5%) in the CTGNB group, which was higher as compared with the transbronchial biopsy or open lung biopsy group (p < 0.01). Subset analyses of p stage IB cases and those with subpleural lesions showed that local recurrence with dissemination was significantly more frequent in the CTGNB group (p = 0.02 and p < 0.01, respectively). In patients with subpleural lesions diagnosed with CTGNB, the rate of local recurrence with dissemination was 15.4%. Propensity score matching analysis confirmed the significantly increased frequency of pleural dissemination after CTGNB.

CONCLUSIONS:

The CTGNB procedure might increase the risk of pleural implantation in stage I lung cancer patients, especially p stage IB cases with subpleural lesions, whereas the overall disease-free survival rate was not affected by this small population of patients with recurrence.

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