Cho Jaeyoung, Ko Sung-Jun, Kim Se Joong, Lee Yeon Joo, Park Jong Sun, Cho Young-Jae, Yoon Ho Il, Cho Sukki, Kim Kwhanmien, Jheon Sanghoon, Lee Jae Ho, Lee Choon-Taek
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
BMC Cancer. 2014 Nov 18;14:838. doi: 10.1186/1471-2407-14-838.
Percutaneous needle aspiration or biopsy (PCNA or PCNB) is an established diagnostic technique that has a high diagnostic yield. However, its role in the diagnosis of nodular ground-glass opacities (nGGOs) is controversial, and the necessity of preoperative histologic confirmation by PCNA or PCNB in nGGOs has not been well addressed.
We here evaluated the rates of malignancy and surgery-related complications, and the cost benefits of resecting nGGOs without prior tissue diagnosis when those nGGOs were highly suspected for malignancy based on their size, radiologic characteristics, and clinical courses. Patients who underwent surgical resection of nGGOs without preoperative tissue diagnosis from January 2009 to October 2013 were retrospectively analyzed.
Among 356 nGGOs of 324 patients, 330 (92.7%) nGGOs were resected without prior histologic confirmation. The rate of malignancy was 95.2% (314/330). In the multivariate analysis, larger size was found to be an independent predictor of malignancy (odds ratio, 1.086; 95% confidence interval, 1.001-1.178, p =0.047). A total of 324 (98.2%) nGGOs were resected by video-assisted thoracoscopic surgery (VATS), and the rate of surgery-related complications was 6.7% (22/330). All 16 nGGOs diagnosed as benign nodules were resected by VATS, and only one patient experienced postoperative complications (prolonged air leak). Direct surgical resection without tissue diagnosis significantly reduced the total costs, hospital stay, and waiting time to surgery.
With careful selection of nGGOs that are highly suspicious for malignancy, surgical resection of nGGOs without tissue diagnosis is recommended as it reduces costs and hospital stay.
经皮针吸活检术（PCNA 或 PCNB）是一种成熟的诊断技术，诊断率较高。然而，其在结节状磨玻璃影（nGGO）诊断中的作用存在争议，nGGO 术前通过 PCNA 或 PCNB 进行组织学确诊的必要性尚未得到充分探讨。
我们评估了恶性肿瘤发生率、手术相关并发症发生率，以及基于大小、影像学特征和临床病程高度怀疑为恶性的 nGGO 在未进行术前组织诊断情况下进行切除的成本效益。对 2009 年 1 月至 2013 年 10 月期间未进行术前组织诊断而接受 nGGO 手术切除的患者进行回顾性分析。
在 324 例患者的 356 个 nGGO 中，330 个（92.7%）nGGO 在未进行术前组织学确诊的情况下被切除。恶性肿瘤发生率为 95.2%（314/330）。多因素分析显示，较大尺寸是恶性肿瘤的独立预测因素（比值比，1.086；95%置信区间，1.001 - 1.178，p = 0.047）。共有 324 个（98.2%）nGGO 通过电视辅助胸腔镜手术（VATS）切除，手术相关并发症发生率为 6.7%（22/330）。所有 16 个被诊断为良性结节的 nGGO 均通过 VATS 切除，只有 1 例患者出现术后并发症（持续性漏气）。未经组织诊断直接进行手术切除显著降低了总成本、住院时间和手术等待时间。
通过仔细选择高度怀疑为恶性的 nGGO，建议对 nGGO 进行未经组织诊断的手术切除，因为这可以降低成本和缩短住院时间。
