Transthoracic needle biopsy versus surgical diagnosis for solid pulmonary nodules.
Autor: | Roy V; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada., Ugalde PA; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada., Bourdages-Pageau E; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada., Lacasse Y; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada., Labbé C; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, QC, Canada. |
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Jazyk: | angličtina |
Zdroj: | Journal of thoracic disease [J Thorac Dis] 2022 Jul; Vol. 14 (7), pp. 2472-2480. |
DOI: | 10.21037/jtd-22-35 |
Abstrakt: | Background: When investigating solitary pulmonary nodules (SPN), non-surgical [such as transthoracic needle biopsy (TTNB)] or surgical biopsies can be performed. There is a paucity of data comparing these two approaches. Methods: This descriptive study is a retrospective analysis of a cohort of 149 patients who underwent TTNB and/or surgery for a SPN >8 mm but ≤3 cm between January and December 2016, at Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Our primary objective was to evaluate the proportion of patients investigated with TTNB vs. surgical diagnosis in our center. Secondary objectives were to examine the distribution of diagnoses (malignancy vs. benign lesion), to evaluate the proportion of TTNB that would yield a benign diagnosis and permit to avoid surgery, to evaluate if delays to surgery were longer when preoperative TTNB was performed, and if operative times were longer with upfront surgery. Results: In our cohort, 87 patients (58%) underwent TTNB, while 62 (42%) had an upfront surgical procedure. One hundred and twenty-eight patients (86%) had a malignant diagnosis. Thirteen patients out of the 87 biopsied (15%) avoided surgery owing to a benign biopsy result, or a non-specific diagnosis and a physician reassured enough to decide for radiological surveillance, while 5/62 patients (8%) who underwent upfront surgery had a benign diagnosis. There was no significant difference in delays from imaging to surgery or in operative time between patients with or without prior TTNB. Conclusions: In this unicentric retrospective cohort of patients investigated for SPN, the malignancy rate was high (86%), which seemed to limit the applicability of prediction models. Adherence to guidelines for the investigation of SPN by physicians seemed suboptimal. More real-world prospective studies are needed to compare non-surgical and surgical biopsies. There is also a need for simpler nodule evaluation algorithms. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-35/coif). The authors have no conflicts of interest to declare. (2022 Journal of Thoracic Disease. All rights reserved.) |
Databáze: | MEDLINE |
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