Yamamoto Kohei, Imabayashi Tatsuya, Kano Yukari, Tanaka Toshiyuki, Jinno Kazuki, Tanaka Shunya, Uda Sayaka, Yuba Tatsuya, Takumi Chieko
Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
Transl Lung Cancer Res. 2025 Jun 30;14(6):2317-2323. doi: 10.21037/tlcr-2025-218. Epub 2025 Jun 26.
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure for diagnosing intrathoracic lymphadenopathy; however, it has limitations in diagnostic yield and sampling adequacy for certain conditions. To address this issue, EBUS-guided intranodal forceps biopsy (EBUS-IFB) and cryobiopsy (EBUS-CRYO) have been performed. Both techniques require the creation of a tract for the insertion of forceps or cryoprobes into the lymph nodes. However, potential adverse events associated with this tract remain unclear. Needle tract seeding (NTS), which is defined as the implantation of tumor cells along the puncture tract, is a rare but clinically significant complication of gastrointestinal procedures. However, its occurrence after bronchoscopy has rarely been reported. This report describes a rare case of NTS following EBUS-IFB and EBUS-CRYO.
An 83-year-old woman with lung adenocarcinoma harboring exon 14 skipping mutation presented with right upper lobe nodules and bilateral mediastinal lymphadenopathy. The initial EBUS-TBNA yielded insufficient specimens for molecular testing. Subsequent EBUS-IFB and mediastinal cryobiopsy provided sufficient specimens for definitive diagnosis. Twenty-nine days after the procedure, computed tomography revealed rapid growth of the right upper lobe nodules and a tracheal mass at the biopsy site, consistent with NTS. Despite this complication, the patient demonstrated a marked response to tepotinib therapy, with significant regression of both the lung and tracheal lesions.
This case highlights the need for increased awareness of NTS following advanced biopsy techniques. Tumor-related factors such as high malignancy and necrosis, combined with procedural elements, likely contribute to its occurrence. Bronchoscopists should carefully evaluate the procedural approaches and follow-up protocols to mitigate this risk and ensure early detection.
支气管内超声（EBUS）引导下经支气管针吸活检（EBUS-TBNA）是诊断胸内淋巴结病变的标准程序；然而，对于某些情况，其诊断率和采样充分性存在局限性。为解决这一问题，已开展了EBUS引导下淋巴结内钳取活检（EBUS-IFB）和冷冻活检（EBUS-CRYO）。这两种技术都需要创建一个通道，以便将钳子或冷冻探头插入淋巴结。然而，与该通道相关的潜在不良事件仍不清楚。针道种植（NTS），定义为肿瘤细胞沿穿刺道种植，是胃肠道手术中一种罕见但具有临床意义的并发症。然而，支气管镜检查后其发生情况鲜有报道。本报告描述了一例EBUS-IFB和EBUS-CRYO术后罕见的NTS病例。
一名83岁的肺腺癌女性，存在外显子14跳跃突变，表现为右上叶结节和双侧纵隔淋巴结肿大。最初的EBUS-TBNA获取的标本不足以进行分子检测。随后的EBUS-IFB和纵隔冷冻活检提供了足够的标本用于明确诊断。术后29天，计算机断层扫描显示右上叶结节迅速增大，活检部位出现气管肿物，符合NTS表现。尽管出现了这一并发症，但患者对替泊替尼治疗反应显著，肺部和气管病变均明显消退。
本病例强调了提高对先进活检技术后NTS认识的必要性。高恶性和坏死等肿瘤相关因素，结合手术操作因素，可能导致其发生。支气管镜检查医师应仔细评估手术方法和随访方案，以降低这种风险并确保早期发现。
