CT引导的针头活检与同侧胸膜转移无关
CT-guided needle biopsy is not associated with increased ipsilateral pleural metastasis
影响因子:4.40000
分区:医学2区 / 肿瘤学3区 呼吸系统3区
发表日期:2024 Aug
作者:
Benedikt Niedermaier, Yao Kou, Elizabeth Tong, Monika Eichinger, Laura V Klotz, Martin E Eichhorn, Thomas Muley, Felix Herth, Hans-Ulrich Kauczor, Claus Peter Heußel, Hauke Winter
摘要
肺肿瘤的组织学确认是治疗计划的先决条件。人们怀疑CT引导的针头活检（CTGNB）使患者暴露于胸腔复发的较高风险。然而，在比较CTGNB与支气管镜检查时，肿瘤和胸膜之间的距离在很大程度上被忽略为可能的混杂因素。在2010年至2020年间，通过支气管镜检查或CTGNB的所有肺癌患者均被纳入和研究。审查了患者的病史，放射学和病理学发现和手术记录。胸膜复发是通过胸腔活检，流体细胞学或通过CT胸部成像诊断出的，显示进行性胸膜结节。确定了27例患者（3.2％）患有同侧胸膜复发（IPR）。在接受CTGNB的患者中，肿瘤与胸膜的距离明显小得多。在下叶的肿瘤中观察到IPR风险增加的趋势（HR：2.18 [±0.43]，p = 0.068），但只有微观胸膜入侵是IPR的增加的显着独立预测因素（HR：HR：5.33 [±0.51]，P = 0.001），P = 0.001），通过多个分析分析。 CTGNB的活检不会影响IPR（HR：1.298 [±0.39]，p = 0.504）。CTGNB是安全的，并且与我们同类群体中IPR的发生率增加无关。在较大的多中心患者队列中，该观察结果尚待验证。
Abstract
Histological confirmation of a lung tumor is the prerequisite for treatment planning. It has been suspected that CT-guided needle biopsy (CTGNB) exposes the patient to a higher risk of pleural recurrence. However, the distance between tumor and pleura has largely been neglected as a possible confounder when comparing CTGNB to bronchoscopy.All patients with lung cancer histologically confirmed by bronchoscopy or CTGNB between 2010 and 2020 were enrolled and studied. Patients' medical histories, radiologic and pathologic findings and surgical records were reviewed. Pleural recurrence was diagnosed by pleural biopsy, fluid cytology, or by CT chest imaging showing progressive pleural nodules.In this retrospective unicenter analysis, 844 patients underwent curative resection for early-stage lung cancer between 2010 and 2020. Median follow-up was 47.5 months (3-137). 27 patients (3.2 %) with ipsilateral pleural recurrence (IPR) were identified. The distance of the tumor to the pleura was significantly smaller in patients who underwent CTGNB. A tendency of increased risk of IPR was observed in tumors located in the lower lobe (HR: 2.18 [±0.43], p = 0.068), but only microscopic pleural invasion was a significant independent predictive factor for increased risk of IPR (HR: 5.33 [± 0.51], p = 0.001) by multivariate cox analysis. Biopsy by CTGNB did not affect IPR (HR: 1.298 [± 0.39], p = 0.504).CTGNB is safe and not associated with an increased incidence of IPR in our cohort of patients. This observation remains to be validated in a larger multicenter patient cohort.