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Operable Non-small Cell Lung Cancer Diagnosed by Transpleural Techniques^*

Do They Affect Relapse and Prognosis?

^* 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.

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.

Key Words: excision • needle aspiration cytology • non-small cell lung cancer

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