Abstract
Objectives
To determine whether percutaneous transthoracic needle biopsy (PTNB) increased the risk of pleural recurrence in stage I non-small-cell lung cancer (NSCLC).
Methods
In this retrospective study, we reviewed 830 consecutive patients with stage I NSCLC who underwent curative resection between 2004 and 2010. Cox regression analyses with propensity score matching were performed to identify risk factors for pleural recurrence.
Results
Of 830 patients, 540 (65.1%) underwent PTNB before surgery, while 290 (34.9%) underwent preoperative bronchoscopic biopsy or intraoperative wedge resection for a pathological diagnosis. Concomitant pleural recurrence occurred in 42 patients (5.1% [95% CI, 3.8–6.8]; 34 [6.3%] PTNB patients and eight [2.8%] non-PTNB patients) and isolated pleural recurrence took place in 26 patients (3.1% [95% CI, 2.1–4.6]; 20 [3.7%] PTNB patients and 6 [2.1%] non-PTNB patients). On multivariate analysis after matching, only visceral pleural invasion was associated with concomitant pleural recurrence (hazard ratio [HR]=3.367; 95% CI, 1.262–8.986; p=0.015) and isolated pleural recurrence (HR=3.216; 95% CI, 1.037–9.978; p=0.043), while PTNB was associated with neither concomitant nor isolated pleural recurrence (p=0.605 and p=0.963, respectively). Among 540 patients undergoing PTNB, the transfissural approach did not have a significant association with pleural recurrence (p=0.539 and p=0.313, respectively); instead, visceral pleural invasion and microscopic lymphatic invasion were significantly associated with concomitant pleural recurrence, and microscopic lymphatic invasion was associated with isolated pleural recurrence (p<0.05).
Conclusion
PTNB did not significantly increase the risk of pleural recurrence in stage I NSCLC, whereas visceral pleural invasion was responsible for pleural recurrence.
Key Points
• PTNB did not significantly increase the risk of pleural recurrence in stage I NSCLC, whereas visceral pleural invasion was responsible for pleural recurrence.
• The transfissural approach in PTNB did not increase the risk of pleural recurrence.
• PTNB can be performed for the confirmatory diagnosis of peripheral stage I lung cancer without concern for the risk of pleural recurrence.
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Abbreviations
- HR:
-
Hazard ratio
- NSCLC:
-
Non-small-cell lung cancer
- PSM:
-
Propensity score matching
- PTNB:
-
Percutaneous transthoracic needle biopsy
References
Gould MK, Donington J, Lynch WR et al (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143:e93S–e120S
Wu CC, Maher MM, Shepard JA (2011) Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 196:W678–W682
Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM (2014) C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 271:291–300
Winokur RS, Pua BB, Sullivan BW, Madoff DC (2013) Percutaneous lung biopsy: technique, efficacy, and complications. Semin Interv Radiol 30:121–127
Ayar D, Golla B, Lee JY, Nath H (1998) Needle-track metastasis after transthoracic needle biopsy. J Thorac Imaging 13:2–6
Tomiyama N, Yasuhara Y, Nakajima Y et al (2006) CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 59:60–64
Asakura K, Izumi Y, Yamauchi Y et al (2012) Incidence of pleural recurrence after computed tomography-guided needle biopsy in stage I lung cancer. PLoS One 7:e42043
Flechsig P, Kunz J, Heussel CP et al (2015) Invasive lung cancer staging: influence of CT-guided core needle biopsy on onset of pleural carcinomatosis. Clin Imaging 39:56–61
Inoue M, Honda O, Tomiyama N et al (2011) Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients. Ann Thorac Surg 91:1066–1071
Kashiwabara K, Semba H, Fujii S, Tsumura S (2016) Preoperative percutaneous transthoracic needle biopsy increased the risk of pleural recurrence in pathological stage I lung cancer patients with sub-pleural pure solid nodules. Cancer Investig 34:373–377
Matsuguma H, Nakahara R, Kondo T, Kamiyama Y, Mori K, Yokoi K (2005) Risk of pleural recurrence after needle biopsy in patients with resected early stage lung cancer. Ann Thorac Surg 80:2026–2031
Moon SM, Lee DG, Hwang NY et al (2017) Ipsilateral pleural recurrence after diagnostic transthoracic needle biopsy in pathological stage I lung cancer patients who underwent curative resection. Lung Cancer 111:69–74
Rami-Porta R, Crowley JJ, Goldstraw P (2009) Review The trevised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg 15:5
Austin PC (2009) Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 38:1228–1234
Wisnivesky JP, Henschke CI, Yankelevitz DF (2006) Diagnostic percutaneous transthoracic needle biopsy does not affect survival in stage I lung cancer. Am J Respir Crit Care Med 174:684–688
Ahn SY, Park CM, Jeon YK et al (2017) Predictive CT features of visceral pleural invasion by T1-sized peripheral pulmonary adenocarcinomas manifesting as subsolid nodules. AJR Am J Roentgenol 209:561–566
Jiwangga D, Cho S, Kim K, Jheon S (2017) Recurrence pattern of pathologic stage I lung adenocarcinoma with visceral pleural invasion. Ann Thorac Surg 103:1126–1131
Shimizu K, Yoshida J, Nagai K et al (2005) Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg 130:160–165
Huang H, Wang T, Hu B, Pan C (2015) Visceral pleural invasion remains a size-independent prognostic factor in stage I non-small cell lung cancer. Ann Thorac Surg 99:1130–1139
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The scientific guarantor of this publication is Soon Ho Yoon.
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The authors of this article declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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One of the authors has significant statistical expertise.
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Written informed consent was waived by the Institutional Review Board.
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Methodology
• Retrospective
• Observational
• Performed at one institution
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Ahn, S.Y., Yoon, S.H., Yang, B.R. et al. Risk of pleural recurrence after percutaneous transthoracic needle biopsy in stage I non-small-cell lung cancer. Eur Radiol 29, 270–278 (2019). https://doi.org/10.1007/s00330-018-5561-5
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DOI: https://doi.org/10.1007/s00330-018-5561-5