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
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
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.