title: Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy.
abstract: OBJECTIVE
  The implantation of cancer cells in the chest wall after percutaneous needle biopsy of the lung is rare. We investigated the clinical outcomes of implantation metastasis after percutaneous fine-needle aspiration biopsy of pulmonary mass suggestive of lung cancer.
  
  
  METHODS
  Between January 1990 and December 2001, nine patients were treated for implantation metastasis of the chest wall. We retrospectively reviewed the patients' records and analyzed their clinical outcomes.
  
  
  RESULTS
  During an 11-year period, 4365 patients underwent percutaneous fine-needle aspiration biopsy for indeterminate pulmonary nodule at Seoul National University Hospital. Eight patients developed implantation metastasis related to the procedure. One patient was presented to us after being biopsied in another hospital. A wide, full-thickness excision of the chest wall was performed in eight patients. In one patient, palliative chemotherapy was performed due to the presence of distant metastases in addition to the local recurrence. In six patients, postoperative adjuvant radiation was given. There was no surgical mortality or morbidity. The median survival was 96.5 months (range, 15-128 months) after pulmonary resection and 75 months (range, 8-93 months) after chest-wall resection. Six patients developed recurrence of the primary cancer in a median of 52 months (range 5-93 months). Three patients recurred at the chest-wall excision site and a wide, full-thickness chest-wall re-resection was performed for two patients who recurred only at the previous chest-wall excision site. Four patients are alive, four have died of recurrent disease, and one died of underlying lung disease. None died of implantation metastasis per se.
  
  
  CONCLUSIONS
  The incidence of chest-wall implantation metastasis after fine-needle aspiration biopsy is extremely rare. With successful resection, the prognosis for the patient seems to depend on the primary cancer. A radical and wide resection in conjunction with irradiation may provide long-term survival in patients with an initial early stage cancer.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. jhkim10@snu.ac.kr
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Young Tae
authors.initials: YT
authors.lastname: Kim
authors.forename: Hong Kook
authors.initials: HK
authors.lastname: Lim
authors.forename: Yong Hee
authors.initials: YH
authors.lastname: Kim
authors.forename: Sook Whan
authors.initials: SW
authors.lastname: Sung
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000473:pathology; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001707:Biopsy, Needle / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000628:therapy; D035441:Thoracic Wall
chemical_list: D000970:Antineoplastic Agents