Pleural recurrence after needle biopsy of the lung: An analysis in patients with completely resected stage I non-small cell lung cancer

Abstract

7177 Background: Percutaneous needle biopsy (PNB) is widely used to obtain tissue for diagnoses in patients with an indeterminate pulmonary nodule. Although tumor seeding into the needle track has been reported often, pleural recurrence after needle biopsy has not yet been widely investigated in operable patients with early stage non-small cell lung cancer. Methods: Between 1986 and 2000, 339 patients with stage I NSCLC underwent complete resection of the lung. We retrospectively reviewed their medical record and investigated the relationship between the diagnostic methods and the recurrence pattern. Results: Preoperative diagnosis was obtained for 294 patients, 223 were diagnosed by bronchoscopy, and 67 were diagnosed by PNB. Among the patients who were not preoperatively diagnosed, 27 were diagnosed by intraoperative needle biopsy (INB), and 14 were diagnosed by wedge resection of the lung. Almost all of the needle biopsy was carried out using the 18-gauge automated cutting biopsy needle (Monopty) since 1994. Tumors diagnosed by needle biopsy including PNB and INB showed smaller tumor sizes and had fewer vessels invasions than those diagnosed by other methods (P < .05). Seventy-one patients had recurrence; distant metastasis occurred in 52 patients, and local recurrence in 22. Among the 22 patients, 8 had pleural recurrence, and 1 had chest wall implantation. In the 9 patients, 7 were diagnosed by needle biopsy. The rate of pleural recurrence including needle track implantation was 0.8% (2 out of 245) in bronchoscopy cases, and 7.3 % (7 out of 94) in needle biopsy cases (P = .003). Among the 9 patients, all four patients without pleural invasion were diagnosed by needle biopsy. Conclusions: Our research has indicated that pleural recurrence could occur as a result of needle biopsy in the same way as chest wall implantation occurs. Furthermore, pleural recurrence may be occurring more frequently than chest wall implantation. Needle biopsy should be avoided in operable patients with stage I non-small cell lung cancer, if the pulmonary lesions have a high probability of being malignant on diagnostic imagings. No significant financial relationships to disclose.