Department of Thoracic Surgery, Thoraxklinik at the University of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
Lung Cancer. 2024 Aug;194:107890. doi: 10.1016/j.lungcan.2024.107890. Epub 2024 Jul 14.
Histological confirmation of a lung tumor is the prerequisite for treatment planning. It has been suspected that CT-guided needle biopsy (CTGNB) exposes the patient to a higher risk of pleural recurrence. However, the distance between tumor and pleura has largely been neglected as a possible confounder when comparing CTGNB to bronchoscopy.
All patients with lung cancer histologically confirmed by bronchoscopy or CTGNB between 2010 and 2020 were enrolled and studied. Patients' medical histories, radiologic and pathologic findings and surgical records were reviewed. Pleural recurrence was diagnosed by pleural biopsy, fluid cytology, or by CT chest imaging showing progressive pleural nodules.
In this retrospective unicenter analysis, 844 patients underwent curative resection for early-stage lung cancer between 2010 and 2020. Median follow-up was 47.5 months (3-137). 27 patients (3.2 %) with ipsilateral pleural recurrence (IPR) were identified. The distance of the tumor to the pleura was significantly smaller in patients who underwent CTGNB. A tendency of increased risk of IPR was observed in tumors located in the lower lobe (HR: 2.18 [±0.43], p = 0.068), but only microscopic pleural invasion was a significant independent predictive factor for increased risk of IPR (HR: 5.33 [± 0.51], p = 0.001) by multivariate cox analysis. Biopsy by CTGNB did not affect IPR (HR: 1.298 [± 0.39], p = 0.504).
CTGNB is safe and not associated with an increased incidence of IPR in our cohort of patients. This observation remains to be validated in a larger multicenter patient cohort.
肺部肿瘤的组织学确认是治疗计划的前提。人们怀疑 CT 引导下的针吸活检（CTGNB）会使患者面临更高的胸膜复发风险。然而，在比较 CTGNB 与支气管镜检查时，肿瘤与胸膜之间的距离在很大程度上被忽视了。
回顾性纳入 2010 年至 2020 年间通过支气管镜或 CTGNB 组织学确诊的肺癌患者，并进行研究。回顾性分析患者的病史、影像学和病理学检查及手术记录。胸膜复发通过胸膜活检、胸腔积液细胞学检查或 CT 胸部成像显示进行性胸膜结节来诊断。
在这项回顾性单中心分析中，2010 年至 2020 年间共有 844 例早期肺癌患者接受了根治性切除术。中位随访时间为 47.5 个月（3-137 个月）。发现 27 例（3.2%）患者发生同侧胸膜复发（IPR）。接受 CTGNB 的患者肿瘤距胸膜的距离明显较小。位于下叶的肿瘤（HR：2.18[±0.43]，p=0.068），IPR 风险增加的趋势更为明显，但只有显微镜下胸膜侵犯是 IPR 风险增加的独立预测因素（HR：5.33[±0.51]，p=0.001）。多因素 Cox 分析。CTGNB 活检并未影响 IPR（HR：1.298[±0.39]，p=0.504）。
在我们的患者队列中，CTGNB 是安全的，与 IPR 的发生率增加无关。这一观察结果有待在更大的多中心患者队列中验证。
