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Lung Adenocarcinomas Diagnosed by Open Lung or Thoracoscopic vs Bronchoscopic Biopsy

Hiroaki Nomori; Hirotoshi Horio; Gentarou Fuyuno; Ryuichirou Kobayashi; Shojiroh Morinaga; Keiichi Suemasu
Author and Funding Information

Affiliations: From the Departments of Thoracic Surgery, Saiseikai Central Hospital, Tokyo,  From the Department of Medicine, Saiseikai Central Hospital, Tokyo,  From the Department of Pathology, Saiseikai Central Hospital, Tokyo

Affiliations: From the Departments of Thoracic Surgery, Saiseikai Central Hospital, Tokyo,  From the Department of Medicine, Saiseikai Central Hospital, Tokyo,  From the Department of Pathology, Saiseikai Central Hospital, Tokyo

Affiliations: From the Departments of Thoracic Surgery, Saiseikai Central Hospital, Tokyo,  From the Department of Medicine, Saiseikai Central Hospital, Tokyo,  From the Department of Pathology, Saiseikai Central Hospital, Tokyo


1998 by the American College of Chest Physicians


Chest. 1998;114(1):40-44. doi:10.1378/chest.114.1.40
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Abstract

Study objectives: To examine the characteristics of peripheral lung adenocarcinomas diagnosed by open lung or video-assisted thoracoscopic surgery (VATS) biopsy.

Design: We used retrospective analysis to compare tumor stage, pleural involvement, central tumor fibrosis, and the number of bronchi or vessels involved with tumors of small peripheral lung adenocarcinomas diagnosed by bronchoscopic biopsy.

Patients: Subjects had lung adenocarcinomas diagnosed by open lung or VATS (n=22) and those diagnosed by bronchoscopic biopsy (n=22), which were matched by tumor size.

Results: The T1N0M0 tumor was notably more frequent in the open lung or VATS group (77.3%) than in the bronchoscopic biopsy group (36.4%) (p<0.01). Tumors invading beyond the pleural surface were less frequent in the open lung or VATS group (4.5%) than in the bronchoscopic biopsy group (40.9%) (p<0.01). The grade of in-tumor central fibrosis—a malignancy factor and the cause of bronchi or vessel involvement with tumors—was significantly lower in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.01). The number of bronchi or vessels involved with tumors was significantly fewer in the open lung or VATS group than in the bronchoscopic biopsy group (p<0.001).

Conclusions: (1) Lung adenocarcinomas diagnosed by open lung or VATS biopsy were more frequently T1N0M0 than those diagnosed by bronchoscopic biopsy, which was caused by low grade of central tumor fibrosis rather than small tumor size. (2) They were infrequently diagnosed by bronchoscopic biopsy because few bronchi were involved by tumors due to the low grade of central tumor fibrosis. (3) Small pulmonary nodules not diagnosable by bronchoscopic biopsy should be diagnosed aggressively using VATS biopsy to detect early-stage lung cancer.


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