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Diagnostic Percutaneous Transthoracic Needle Biopsy Does Not Affect Survival in Stage I Lung Cancer

Divisions of General Internal Medicine and Pulmonary, Critical Care Medicine, and Sleep Medicine, Mount Sinai School of Medicine; Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York

Correspondence and requests for reprints should be addressed to Juan P. Wisnivesky, M.D., M.P.H., Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029. E-mail: juan.wisnivesky{at}mssm.edu

Rationale: Lung cancer dissemination has been cited as a potential adverse consequence of diagnostic percutaneous transthoracic needle biopsy (PTNB) of lung nodules. Despite multiple reports in the literature of malignant spread along the needle track, the potential effect of lung cancer dissemination after PTNB on survival is unknown.

Objective: To evaluate whether diagnostic PTNB is associated with increased risk of lung cancer death.

Methods: This study included 8,607 cases of surgically resected stage I non–small cell lung cancer diagnosed between 1991 and 1999 from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare records. Overall and lung cancer–specific survival of patients who had and did not have PTNB was compared using Kaplan-Meier curves. Stratified survival analyses and Cox regression were used to compare survival with adjustment for potential confounders.

Results: Approximately 36% of patients underwent diagnostic PTNB. Overall and lung cancer–specific survival did not differ in patients that underwent PTNB as part of their cancer diagnostic work-up and those who did not (p = 0.57 and 0.46, respectively). In stratified and multivariate analysis, PTNB was not associated with an increased risk of death after controlling for age, race, income, access to care, comorbidities, tumor histology and size, and type of treatment received.

Conclusions: In this large national sample, preoperative PTNB was not associated with increased risk of death. These data suggest that PTNB can be safely used for the work-up of pulmonary nodules when there is a suspicion of lung cancer.

Key Words: diagnosis • lung cancer • needle biopsy • survival

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