(Chest. 2001;120:1595-1598.)
Operable Non-small Cell Lung Cancer Diagnosed by Transpleural Techniques*
Do They Affect Relapse and Prognosis? Noriyoshi Sawabata, MD, FCCP;  Hajime Maeda, MD;  Mitsunori Ohta, MD and  Masanobu Hayakawa, MD
[size=-1]* From the Division of Surgery (Drs. Sawabata and Maeda), Toneyama National Hospital, Toyonaka, Osaka; Division of General Thoracic Surgery (Dr. Ohta), Department of Surgery (E-1), Osaka University Graduate School of Medicine, Osaka; and Division of Surgery (Dr. Hayakawa), Toyonaka City General Hospital, Toyonaka, Japan.  

[size=-1]Correspondence to: Noriyoshi Sawabata, MD FCCP, Division of Surgery, Toneyama National Hospital, 5–1-1 Toneyama, Toyonaka, Osaka, Japan; e-mail: nori{at}toneyama.hosp.go.jp
Study objective: We assessed whether transpleural methods for diagnosing peripheral lung cancer, such as needle aspiration or tumor excision, affect relapse and prognosis, because these techniques have potential to spread malignant cells from the tumor.
Design: A retrospective study.
Setting: National referral hospital.
Patients: We reviewed 239 patients who underwent surgery between 1990 and 1998 and for whom non-small cell lung cancer (NSCLC) of < 3 cm in maximum diameter was completely resected. The duration of postoperative follow-up ranged from 12 to 105 months, with a median period of 45 months.
Interventions: We defined the transbronchial method as using a bronchoscope, and the transpleural method as using needle aspiration cytology or tumor excision. Dichotomous variables included gender, histologic type of squamous cell carcinoma or other type of carcinoma, pathologic stage, and whether the diagnostic method was the transbronchial type only (first-line method) or the transpleural type (second-line method).
Results: NSCLC was diagnosed in 45 patients by the transpleural technique and in 194 patients by the transbronchial technique. There were no significant statistical differences in age of patients, gender, histologic type, pathologic stage, and tumor size. There were 42 relapses, 7 in the transpleural technique group and 35 in the transbronchial technique group (p = 0.90). Of the 7 patients in the transpleural group, there were 4 distant metastasis and 3 local relapses; of the 35 patients in the transbronchial group, there were 20 distant metastasis and 15 local relapses (p = 0.99). Pleural carcinomatosis occurred in none of the 45 patients in the transpleural group and in 1 case (0.5%) in the 194 patients in the transbronchial group (p = 0.99). Patients in the transpleural group had a statistically better 5-year survival rate than patients in the transbronchial group (79.4% vs 60.3%, p = 0.04). This is also confirmed as an independent prognostic factor in a multivariate analysis.
Conclusions Transpleural methods seem to be an advisable way to diagnose operable lung cancer that is difficult to diagnose using bronchoscopy, because these methods did not affect relapse and prognosis in the patients in our study.    

Eur J Cardiothorac Surg 2003;23:828-832

Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy
Joo Hyun Kim*, Young Tae Kim, Hong Kook Lim, Yong Hee Kim, Sook Whan Sung
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongun-Dong, Chongro-Ku, Seoul, 110-744, South Korea


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.

日本Sawabata等的研究证实，可手术的肺癌患者，采用经胸膜活检术确诊，不增加肿瘤复发率。

    由于经胸膜活检有导致肿瘤播散的潜在危险，日本Sawabata等评估了经胸膜活检（针吸活检或切取肿瘤活检）诊断外周肺癌是否会影响肿瘤复发及预后。

    Sawabata等回顾分析了1990～1998年接受手术的239例病人。所选病例均为非小细胞肺癌，肿块最大直径< 3 cm，并均经手术完全切除。术后随访12～105个月，中位随访时间为45个月。病人资料包括：性别、鳞癌及其它癌的组织病理学类型、病理学分期、诊断方法（仅用经支气管镜技术或经胸膜技术）。（Chest 2001，120∶1595）

    结果显示，45例病人采用经胸膜活检术确诊为非小细胞肺癌，194例病人采用经支气管镜活检术确诊为非小细胞肺癌。两组病人的年龄、性别、组织学类型、病理分期及肿瘤大小均无显著差异。共有42例病人复发，其中经胸膜活检术组7例，经支气管镜活检术组35例（P=0.09）。45例胸膜活检组病人无1例出现胸膜多发癌，194例经支气管镜活检组病人中，1例（0.5％）出现胸膜多发癌。经胸膜活检组病人5年生存率比经支气管镜活检组病人显著高（分别为79.4％及60.3％，P=0.04）。

    研究者认为，对于经支气管镜难以确诊的病人，可采用经胸膜活检术。         

近日，来自梅奥诊所的研究人员通过对超过2000名胰腺癌病人进行研究表示，人们不必担心进行癌症的活组织检查会促进癌症扩散，相关文章刊登于国际杂志Gut上，该研究表明，相比未活组织检查的病人而言，进行活组织检查的患者或许会有一个较好的预后及较长的生存期。

细针穿刺是一种侵入性最小的技术，研究人员利用该技术来提取肿瘤组织中的细胞，然而长期以来一直有患者和一些医生认为这种做法会促进某些癌细胞扩散；研究者Michael Wallace教授说道，本文研究显示，进行癌症活组织检查是非常安全的，我们每年在美国进行上百万个癌症的活组织检查，仅有1至2个案例研究提示活组织会使得癌症扩散。

活组织检查会为研究人员后期对患者进行疗法提供导向作用，而在某些研究中，在对患者进行手术前用化疗和放疗进行治疗会明显改善患者的预后。对胰腺癌进行手术是一项非常具有挑战性的任务，大部分的患者想确保他们在手术后是否会治愈，但有一项研究表明，9%的接受胰腺癌手术的患者怀疑自己是胰腺癌，最终却发现是良性疾病。

本文研究中，研究人员检查了1998年至2009年11年间进行手术的非转移性胰腺癌患者的医疗数据，并且分析了进行超声内镜引导下细针穿刺活检术（EUS-FNA）的498名患者及1536名未进行活组织检查的患者的总体生存率及胰腺癌特异性生存率；结果显示，在平均21个月时间内，有285名（57%）EUS-FNA组的患者及1167名（76%）的非EUS-FNA组的患者死亡了，而胰腺癌可以作为引发251名（50%）EUS-FNA组患者及980名（64%）的非EUS-FNA组的患者死亡的原因。

最后研究者Wallace说道，非EUS-FNA组患者的平均存活期(median overall survival)为15个月，而EUS-FNA组患者的平均存活期则为22个月；对患者来讲进行活组织检查非常有价值，其可以帮助研究人员不断改善个体的治疗策略，从而为有效改善患者的生存率及生活质量提供帮助。