Outcomes/Effectiveness Research

Use of needle biopsy to diagnose lung nodules does not increase the risk of dying from localized nonsmall cell lung cancer

Needle biopsy of the lung is commonly used to evaluate single lung nodules for suspected cancer. The goal is to diagnose existing cancer and to spare patients without malignant nodules from unnecessary surgery. Although uncommon, percutaneous transthoracic needle biopsy (PTNB) can spread cancer cells along the needle track into the lungs. However, a new study confirms that cancer spread due to PTNB is indeed a rare event, and that this procedure does not increase the risk of dying from localized lung cancer. The researchers examined 8,607 cases of surgically resected stage 1 nonsmall cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology, and End Results (SEER) registry, which they linked to Medicare records. They compared overall and lung cancer-specific survival of patients who had and did not have PTNB.

About one-third (36 percent) of patients underwent diagnostic PTNB. Overall survival and survival of specific lung cancers did not differ in patients that underwent PTNB as part of their cancer diagnostic workup and those who did not, even more than 5 years after diagnosis. Since the estimated time to local recurrence after PTNB is 6 to 26 months, these data strongly suggest that lung cancer dissemination after PTNB is a rare event having no significant impact on lung cancer curability or clinical outcomes, concludes Juan P. Wisnivesky, M.D., M.P.H., of Mount Sinai School of Medicine.

PTNB was not associated with an increased risk of death, even after accounting for other factors affecting risk of death, such as tumor histology and size, type of treatment received, coexisting medical conditions, age, race, income, and access to care. These findings suggest that PTNB can be safely used for the workup of pulmonary nodules when there is a suspicion of lung cancer. The study was supported by the Agency for Healthcare Research and Quality (HS13312).

See "Diagnostic percutaneous transthoracic needle biopsy does not affect survival in stage 1 lung cancer," by Dr. Wisnivesky, Claudia I. Henschke, Ph.D., M.D., and David F. Yankelevitz, M.D., in the September 2006 American Journal of Respiratory and Critical Care Medicine 174(6), pp. 684-688.

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