title: Percutaneous computed tomography-guided lung biopsy and pleural dissemination: an assessment by intraoperative pleural lavage cytology.
abstract: BACKGROUND
  Percutaneous computed tomography (CT)-guided needle biopsy remains one of the most important diagnostic tools in the management of lung nodules; however, it carries a risk of intrapleural dissemination of cancer cells.
  
  
  METHODS
  CT-guided lung biopsy was performed before surgery in 171 (34.8%) of 491 patients. A coaxial biopsy system was used that comprised a 19-gauge introducer needle and a 20-gauge core biopsy needle. A total of 412 (83.9%) of the 491 patients underwent intraoperative pleural lavage cytology just after thoracotomy. Intraoperative pleural lavage cytology was performed immediately after opening the thorax, after the pleural cavity was gently washed with 50 mL of saline.
  
  
  RESULTS
  No patients had implantation of cancer cells in the chest wall after a median follow-up of 20.2 months. Intraoperative pleural lavage cytology results were positive for 5 (2.9%) of the 171 patients who underwent CT-guided biopsy before surgery, in contrast to 13 (5.4%) of the 241 patients who did not undergo biopsy before surgery. The difference between the biopsy and nonbiopsy groups was not statistically significant. When the analysis was limited to patients with stage IA disease, intraoperative pleural lavage cytology results were positive for 1 (0.8%) of the 128 patients who underwent CT-guided biopsy, in contrast to 3 (2.7%) of the 110 patients who did not undergo biopsy. This difference was also not statistically significant.
  
  
  CONCLUSIONS
  No significant association was observed between percutaneous CT-guided lung biopsy and intraoperative pleural lavage cytology results, even in patients with stage IA disease. Percutaneous CT-guided lung biopsy with a coaxial needle does not seem to cause pleural dissemination.
authors.affiliation: Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. ysano@md.okayama-u.ac.jp
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Sano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Shinichi
authors.initials: S
authors.lastname: Toyooka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Oto
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamane
authors.forename: Takao
authors.initials: T
authors.lastname: Hiraki
authors.forename: Hideo
authors.initials: H
authors.lastname: Gobara
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Mimura
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D010997:Pleural Neoplasms / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed