手术活检对疑似早期肺癌的不明结节进行组织学诊断的疗效和成本效益：与经皮穿刺活检的比较。
Efficacy and Cost-effectiveness of Surgical Biopsy for Histologic Diagnosis of Indeterminate Nodules Suspected for Early Stage Lung Cancer: Comparison with Percutaneous Needle Biopsy.
机构信息
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2020 Jul 20;35(28):e261. doi: 10.3346/jkms.2020.35.e261.
BACKGROUND
Indeterminate pulmonary nodules (IPN) suspected for early stage lung cancer mandate accurate diagnosis. Both percutaneous needle biopsy (PCNB) and surgical biopsy (SB) are valuable options. The present study aimed to compare the efficacy and cost-effectiveness between PCNB and SB for IPN suspected for early stage lung cancer.
METHODS
During January-November 2018, patients who underwent operation for IPN suspected for early stage lung cancer (SB group, n = 245) or operation after PCNB (PCNB group, n = 113) were included. Patient-level cost data were extracted from medical bills from the institution. Propensity score matching was performed between the two groups from a retrospectively-collected database.
RESULTS
Fifteen patients (11.5%) had complications after PCNB; thirteen (11.5%) were not confirmed to have lung cancer through PCNB but underwent operation for IPN. In SB group, 172 (70.2%) and 7 (2.9%) patients underwent wedge resection and segmentectomy for SB, respectively; 66 patients (26.9%) underwent direct lobectomy without SB. After propensity score matching, 58 paired samples were produced. Most patients in PCNB group were admitted twice (n = 55, 94.8%). The average hospital stay was longer in PCNB group (12.9 ± 5.3 vs. 7.3 ± 3.0, < 0.001). Though the cost of the operation was comparable (USD 12,509 ± 2,909 vs. 12,669 ± 3,334; = 0.782), the total cost was higher for PCNB group (USD 14,403 ± 3,085 vs. 12,669 ± 3,334; = 0.006). The average subcategory cost, which increases proportional to hospital stay, was higher in PCNB group, whereas the cost of operation and surgical materials were comparable between the two groups.
CONCLUSION
Lung cancer operation following SB for IPN was associated with lesser cost, shorter hospital stays, and lesser admission time than lung cancer operation after PCNB. The increased cost and longer hospital stay appear largely related to the admission for PCNB.
背景
疑似早期肺癌的肺部不定性结节（IPN）需要准确诊断。经皮穿刺活检（PCNB）和外科活检（SB）都是有价值的选择。本研究旨在比较 PCNB 和 SB 对疑似早期肺癌的 IPN 的疗效和成本效益。
方法
2018 年 1 月至 11 月期间，对因疑似早期肺癌而行手术治疗的 IPN 患者（SB 组，n=245）或 PCNB 后行手术治疗的患者（PCNB 组，n=113）进行了回顾性分析。从医院的医疗账单中提取患者层面的成本数据。从回顾性收集的数据库中对两组患者进行倾向评分匹配。
结果
15 例（11.5%）患者在 PCNB 后出现并发症；13 例（11.5%）PCNB 未能确诊肺癌，但因 IPN 而行手术。SB 组中，172 例（70.2%）和 7 例（11.5%）患者分别行楔形切除术和肺段切除术；66 例（26.9%）患者未行 SB 直接行肺叶切除术。经过倾向评分匹配，共产生 58 对样本。PCNB 组中大多数患者住院两次（n=55，94.8%）。PCNB 组的平均住院时间较长（12.9±5.3 vs. 7.3±3.0， < 0.001）。虽然手术费用相当（12509 美元±2909 美元 vs. 12669 美元±3334 美元； = 0.782），但 PCNB 组的总费用较高（14403 美元±3085 美元 vs. 12669 美元±3334 美元； = 0.006）。与住院时间成正比的亚组成本在 PCNB 组中较高，而两组之间的手术费用和手术材料费用相当。
结论
与 PCNB 后行肺癌手术相比，SB 治疗 IPN 相关肺癌的成本较低，住院时间较短，住院次数较少。增加的成本和较长的住院时间似乎主要与 PCNB 相关。
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