Thoracoscopy or CT-guided biopsy for residual intrathoracic masses after treatment of lymphoma.
BACKGROUND
An intrathoracic mass persists after completion of treatment in 20% of the patients treated for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL). Gallium scan and positron emission tomography allow for diagnosis in most cases. However, in some patients, a pathologic examination of the residual mass (RM) is required. The aim of this study was to evaluate the results of a thoracoscopic approach for intrathoracic RM, as compared with image-guided biopsies.


METHODS
From 1996 to 1998, 29 consecutive patients treated for NLH (n = 11) or HD (n = 18) were referred either to radiology (group R; n = 8) or to surgery (group S; n = 21) for biopsy of an intrathoracic RM. There were 13 male and 16 female patients ranging in age from 15 to 56 years (mean, 32 years). The reason for a biopsy was the inability to determine the nature of the RM by means of radiologic examination or scintigraphy. Biopsy was defined as successful when (1) residual lymphoma was found in the specimen, or (2) benign tissue was found and the patient remained disease-free after a minimal follow-up period of 12 months. A biopsy was defined as a failure when a local recurrence occurred in a patient with a diagnosis of benign lesion.


RESULTS
No significant procedure-related complications occurred in either group. The mean follow-up was 26 months (range, 13 to 72 months). In group R, residual lymphoma was found in only one patient. In group S, residual lymphoma was found in seven patients (p = 0.5). In the seven patients of group R with a diagnosis of benign mediastinal lesion, two patients had a local recurrence and one had a recurrence within the abdomen. In the 15 patients of group S in whom no residual disease was found, 1 patient had an intrathoracic recurrence (p = 0.5) while 2 patients had recurrence in a remote site.


CONCLUSIONS
Despite the limited number of patients in this series, results suggest that a thoracoscopic approach yields better data than image-guided biopsies.
Gossot
D
D
Thoracic Department, Institut Mutualiste Montsouris, Paris, France. dominique.gossot@imm.fr
Girard
P
P
de Kerviler
E
E
Brice
P
P
Rain
J D
JD
Leblanc
T
T
Grunenwald
D
D
D000293:Adolescent; D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D018365:Neoplasm, Residual / Q000175:diagnosis; D015641:Radiography, Interventional; D013899:Thoracic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed