Repeat Needle Biopsy May Prevent Unnecessary Surgery

Repeat Needle Biopsy May Prevent Unnecessary Surgery

According to the results of a recent study published in Cancer, solitary pulmonary nodules may be monitored with repeat needle biopsies, clinical observation and repeat CT scans with 100% accuracy.

Solitary pulmonary nodules are singular lesions that are found in the lungs and are surrounded by normal lung tissues. Pulmonary nodules can be seen by x-rays or during a CT scan of the chest. Usually a nodule is defined as a lesion that is less than 3 centimeters; nodules greater than 3 centimeters are considered to be a mass. These nodules do not involve the lymph nodes. Solitary nodules may be benign or malignant and the list of possible causes is long; however, treatment decisions are often based on whether or not the nodule is cancerous. In most cases, patients with solitary pulmonary nodules have no symptoms and the nodules are frequently benign. The goal of investigating these nodules is to detect cancerous nodules or changes as soon and as accurately as possible. Biopsies of the nodules can be taken in 3 different types of procedures: bronchoscopy, percutaneous needle biopsy or by surgery to remove the nodules.

This recent study was conducted at a lung cancer referral center and involved 118 patients with solitary pulmonary nodules measuring less than 4cm, which were seen by CT scan. In the study, 118 patients underwent 194 biopsy procedures; 137 had biopsies performed by bronchoscopy (transbronchial biopsy) and 57 underwent needle biopsies (percutaneous needle aspiration). In addition, each patient received clinical observation, repeat CT scans and repeat biopsies in an effort to reduce the need for surgical intervention.

Results of the study found that after an average of 4 years of follow up, the incidence of malignancy was 61%. These results were also found to be 100% sensitive, specific, and accurate for detecting malignant changes in these nodules.

Researchers concluded that repeat needle biopsies in addition to repeat CT scans and clinical observation is an accurate way to classify solitary nodules as either benign or malignant. Their recommendation includes initial evaluation of the nodules with a transbronchial biopsy followed by needle biopsies. In addition, clinical observation, and repeat CT scans should be used as needed for any continued suspicion of cancer. These interventions appear to reduce unneeded surgery rates from 60% to 5% without affecting the overall survival of patients who may have malignant solitary pulmonary nodules.

Reference: Welker J, Alatter M, Gautam S, et al. Repeat Needle Biopsies Combined With Clinical Observation are Safe and Accurate in the Management of a Solitary Pulmonary Nodule. Cancer. 2005; 103: 599-607.

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