Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Ann Thorac Surg. 2011 Apr;91(4):1066-71. doi: 10.1016/j.athoracsur.2010.12.032.
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.
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.
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.
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.
计算机断层引导经皮穿刺活检（CTGNB）是一种有用的选择，可用于肺癌的病理诊断，特别是在周围小尺寸结节的患者中。我们旨在评估癌细胞胸膜播种的风险，导致术后复发和播散。
我们调查了 447 例 I 期肺癌患者的临床结果。使用 Kaplan-Meier 方法和对数秩检验进行生存分析。还确定了胸膜复发率。此外，使用倾向评分匹配分析来减少患者特征的背景偏差。
CTGNB 诊断的患者 5 年无病生存率为 89.1%，经支气管活检或开胸肺活检诊断的患者为 85.5%。在 CTGNB 组的 13 例复发病例中，有 8 例（61.5%）出现局部复发伴胸膜播散，高于经支气管活检或开胸肺活检组（p < 0.01）。p 期 IB 病例和亚胸膜病变的亚组分析表明，CTGNB 组局部复发伴播散的频率明显更高（p = 0.02 和 p < 0.01）。在 CTGNB 诊断的亚胸膜病变患者中，局部复发伴播散的发生率为 15.4%。倾向评分匹配分析证实 CTGNB 后胸膜播散的频率明显增加。
CTGNB 可能会增加 I 期肺癌患者胸膜种植的风险，特别是伴有亚胸膜病变的 p 期 IB 病例，而总体无病生存率不受这一小部分复发患者的影响。
