CT引导针吸活检与同侧胸膜转移的关系研究

CT-guided needle biopsy is not associated with increased ipsilateral pleural metastasis

LUNG CANCER

影响因子:4.4

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

DOI: 10.1016/j.lungcan.2024.107890

摘要

肺肿瘤的组织学确认是治疗方案制定的前提。有研究怀疑CT引导针吸活检（CTGNB）可能增加胸膜复发的风险，但在比较CTGNB与支气管镜活检时，肿瘤与胸膜的距离作为潜在混杂因素被忽视。纳入2010年至2020年间经支气管镜或CTGNB确诊的肺癌患者，回顾分析其医疗史、影像和病理结果及手术记录。胸膜复发通过胸膜活检、液体细胞学或CT显示的胸膜结节进展判断。在这项单中心回顾性分析中，共有844例患者接受早期肺癌根治性切除，随访中位时间为47.5个月（3-137个月），发现27例（3.2%）出现同侧胸膜复发（IPR）。CTGNB组肿瘤与胸膜的距离显著较短。低叶肿瘤发生IPR的风险倾向较高（HR：2.18 [±0.43], p=0.068），但多变量Cox分析显示，唯一显著的独立预测因素为显微胸膜侵袭（HR：5.33 [±0.51], p=0.001）。多次活检未影响IPR发生（HR：1.298 [±0.39], p=0.504）。结论：CTGNB安全且在本队列中未增加IPR发生风险，此观察仍需在更大规模的多中心队列中验证。

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.