title: Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients.
abstract: BACKGROUND
  A computed tomographic-guided percutaneous needle biopsy (CTGNB) is useful as an option for pathologic diagnosis of lung cancer, especially in patients with peripheral small-sized nodules. We aimed to assess the risk of pleural seeding of cancer cells, leading to postoperative relapse with dissemination caused by the procedure.
  
  
  METHODS
  We investigated the clinical outcomes of 447 stage I lung cancer patients. Survival analysis was performed using the Kaplan-Meier method and a log-rank test. Pleural recurrence rates were also determined. Furthermore, propensity score matching analysis was used to reduce background bias from patient characteristics.
  
  
  RESULTS
  The 5-year, disease-free survival rate was 89.1% in patients diagnosed with CTGNB, and 85.5% in those diagnosed using a transbronchial biopsy or open lung biopsy procedure. Local recurrence with pleural dissemination was found in 8 of 13 recurrence cases (61.5%) in the CTGNB group, which was higher as compared with the transbronchial biopsy or open lung biopsy group (p < 0.01). Subset analyses of p stage IB cases and those with subpleural lesions showed that local recurrence with dissemination was significantly more frequent in the CTGNB group (p = 0.02 and p < 0.01, respectively). In patients with subpleural lesions diagnosed with CTGNB, the rate of local recurrence with dissemination was 15.4%. Propensity score matching analysis confirmed the significantly increased frequency of pleural dissemination after CTGNB.
  
  
  CONCLUSIONS
  The CTGNB procedure might increase the risk of pleural implantation in stage I lung cancer patients, especially p stage IB cases with subpleural lesions, whereas the overall disease-free survival rate was not affected by this small population of patients with recurrence.
authors: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. mi@thoracic.med.osakau.ac.jp
authors: Masayoshi
authors: M
authors: Inoue
authors: Osamu
authors: O
authors: Honda
authors: Noriyuki
authors: N
authors: Tomiyama
authors: Masato
authors: M
authors: Minami
authors: Noriyoshi
authors: N
authors: Sawabata
authors: Yoshihisa
authors: Y
authors: Kadota
authors: Yasushi
authors: Y
authors: Shintani
authors: Yuko
authors: Y
authors: Ohno
authors: Meinoshin
authors: M
authors: Okumura
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D010997:Pleural Neoplasms / Q000453:epidemiology*; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed