title: Thoracoscopic coaxial cutting needle biopsy for clinically suspected lung cancer: technical details, diagnostic accuracy, and probable complications.
abstract: BACKGROUND
  Little has been described regarding the technical details, diagnostic accuracy, and probable complications of thoracoscopic cutting needle biopsy, which seems to be preferable to transthoracic needle biopsy for patients scheduled to undergo surgery for suspected lung cancer.
  
  
  METHODS
  This study was a retrospective analysis of a prospective database of patients who underwent surgical biopsy for suspected lung cancer (n = 176). Sixty-two patients underwent thoracoscopic cutting needle biopsy, which was performed via thoracoport using a 16 gauge coaxial cutting needle; the remaining 114 patients underwent excisional biopsy, followed by curative intent surgery.
  
  
  RESULTS
  The sensitivity and specificity of diagnosing lung cancer by thoracoscopic needle biopsy were 57/59 (96.6%) and 1/3 (33.3%), respectively. One false-negative result and one undiagnostic result occurred, but both lesions were correctly re-diagnosed by backup excisional biopsy during the same operation. When analysis was restricted to patients with lung lesions predominantly presenting with ground glass opacity, the sensitivity and specificity were 13/14 (92.9%) and 1/1 (100%), respectively. The sensitivity, specificity, and accuracy of diagnosing lung cancer by surgical biopsy in all patients were 164/165 (99.4%), 9/11 (81.8%), and 173/176 (98.3%), respectively. Pleural recurrence was identified in one patient after thoracoscopic needle biopsy whose pleural lavage cytology, performed before biopsy, was negative.
  
  
  CONCLUSIONS
  Thoracoscopic cutting needle biopsy can be effectively applied to patients with an indeterminate lung tumor, especially those patients with lesions possessing ground glass opacity. However, further evaluation is necessary to confirm the risk of pleural dissemination induced by this procedure.
authors.affiliation: Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. kaueda@c-able.ne.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ueda
authors.forename: Toshiki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Masataro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Hoshii
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D004867:Equipment Design; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*