Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Cancer. 2009 Dec 1;115(23):5526-33. doi: 10.1002/cncr.24620.
Percutaneous computed tomography (CT)-guided needle biopsy remains one of the most important diagnostic tools in the management of lung nodules; however, it carries a risk of intrapleural dissemination of cancer cells.
CT-guided lung biopsy was performed before surgery in 171 (34.8%) of 491 patients. A coaxial biopsy system was used that comprised a 19-gauge introducer needle and a 20-gauge core biopsy needle. A total of 412 (83.9%) of the 491 patients underwent intraoperative pleural lavage cytology just after thoracotomy. Intraoperative pleural lavage cytology was performed immediately after opening the thorax, after the pleural cavity was gently washed with 50 mL of saline.
No patients had implantation of cancer cells in the chest wall after a median follow-up of 20.2 months. Intraoperative pleural lavage cytology results were positive for 5 (2.9%) of the 171 patients who underwent CT-guided biopsy before surgery, in contrast to 13 (5.4%) of the 241 patients who did not undergo biopsy before surgery. The difference between the biopsy and nonbiopsy groups was not statistically significant. When the analysis was limited to patients with stage IA disease, intraoperative pleural lavage cytology results were positive for 1 (0.8%) of the 128 patients who underwent CT-guided biopsy, in contrast to 3 (2.7%) of the 110 patients who did not undergo biopsy. This difference was also not statistically significant.
No significant association was observed between percutaneous CT-guided lung biopsy and intraoperative pleural lavage cytology results, even in patients with stage IA disease. Percutaneous CT-guided lung biopsy with a coaxial needle does not seem to cause pleural dissemination.
经皮 CT 引导下的针吸活检仍然是肺结节管理中最重要的诊断工具之一；然而，它存在癌细胞胸膜内播散的风险。
在 491 例患者中的 171 例（34.8%）进行了手术前 CT 引导下的肺活检。使用同轴活检系统，该系统包括 19 号活检针和 20 号活检针芯。491 例患者中的 412 例（83.9%）在开胸后立即进行了术中胸腔灌洗细胞学检查。开胸后，立即在胸腔轻轻冲洗 50 毫升生理盐水后进行术中胸腔灌洗细胞学检查。
中位随访 20.2 个月后，所有患者均无癌细胞植入胸壁。与未进行活检的 241 例患者中的 13 例（5.4%）相比，在手术前进行 CT 引导活检的 171 例患者中有 5 例（2.9%）术中胸腔灌洗液细胞学检查阳性。活检组与非活检组之间的差异无统计学意义。当分析仅限于 IA 期疾病患者时，在手术前进行 CT 引导活检的 128 例患者中有 1 例（0.8%）术中胸腔灌洗液细胞学检查阳性，而未进行活检的 110 例患者中有 3 例（2.7%）。这一差异也没有统计学意义。
即使在 IA 期疾病患者中，经皮 CT 引导下的肺活检与术中胸腔灌洗细胞学检查结果之间也没有明显的关联。同轴针经皮 CT 引导下的肺活检似乎不会引起胸膜播散。
