close attention objective: We assessed whether transpleural systems for diagnosing peripheral lung cancer.

close attention objective: We assessed whether transpleural systems for diagnosing peripheral lung cancer, similar as needle aspiration or tumor excision, affect relapse and prognosis, because these techniques have potential to spread malignant lonely dwellings from the tumor.

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 solitary abode; squalid lung cancer (NSCLC) of < 3 cm in maximum diameter was completely resect The duration of postoperative follow-up ranged from 12 to 105 month with a median period of 45 months

Interventions: We defined the transbronchial [i]modus operandi[/i] as using a bronchoscope, and the transpleural order as using needle aspiration cytology or tumor excision. Dichotomous variables included sex histologic type of squamous confined apartment carcinoma or other type of carcinoma, pathologic stage, and whether the diagnostic means was the transbronchial type single (first-line method) or the transpleural protoplast (second-line method).

Results: NSCLC was diagnosed in 45 patients by dint of the transpleural technique and in 194 patients at the transbronchial technique. There were no significant statistical differences in age of patients, inflection for sex histologic type, pathologic stage, and tumor size. There were 42 relapses, 7 in the transpleural technique collection and 35 in the transbronchial technique assemblage (p = 0.90). Of the 7 patients in the transpleural dispose there were 4 distant metastasis and 3 local relapses; of the 35 patients in the transbronchial arrange there were 20 distant metastasis and 15 local relapses (p = 099) Pleural carcinomatosis occurr in none of the 45 patients in the transpleural cluster and in 1 case (05%) in the 194 patients in the transbronchial clump (p = 0.99). Patients in the transpleural dispose had a statistically better 5-year survival rate than patients in the transbronchial collection (79.4% vs 60.3%, p = 004) This is also confirmed as an independent prognostic factor in a multivariate analysis.

Conclusions Transpleural regularitys seem to be an advisable way to diagnose operable lung cancer that is difficult to diagnose using bronchoscopy because these regularitys did not affect relapse and prognosis in the patients in our reflection (CHEST 2001; 120:1595-1598)

key-note words: excision; needle aspiration cytology; non-small lonely dwelling lung cancer

Abbreviations: NSCLC = non-small small room lung cancer; VATS = video-assisted thoracic surgery

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The transbronchial approach using a bronchoscope is common of the most common rules of diagnosing lung cancer. one peripheral lung cancers, which cannot be diagnosed employing a bronchoscope are diagnosed by the agency of a transpleural method such as needle aspiration cytology (1-3) or tumor excision. (45) These techniques have the potential to spread malignant lonely dwellings from the tumor. Chest wall implantation is a serious cause of morbidity. (6-8) Besides, dissemination of lung cancer small cavitys by needle biopsy of the lung (9) and pleural carcinomatosis following tumor excision using video-assisted thoracic surgery (VATS) (610) have been reported. on contrast, it has been reported (11) that lung adenocarcinoma diagnosed through excision more frequently shows a smaller station of central fibrosis on histologic examination, and may have well adapted prognosis. There are ambivalent opinions regarding the prognosis of nonsmall confined apartment lung cancer (NSCLC) diagnosed according to the transpleural method. In order to assess whether or not transpleural systems for diagnosing peripheral lung cancer affect relapse and prognosis, we leadershiped a retrospective study by classifying patients with NSCLC into pair groups: patients with NSCLC diagnosed by dint of the transbronchial method and patients with NSCLC diagnosed at the transpleural methods.

MATERIALS AND METHODS

We chose patients who underwent surgery between 1990 and 1998 and for whom NSCLC of < 3 cm in maximum diameter was completely resect at Toneyama National Hospital, in Osaka, Japan. Lung cancers diagnosed on needle aspiration cytology or tumor excision were all < 3 cm in maximum diameter; therefore, we pickeded lung cancers < 3 cm in maximum diameter in the transbronchial collection During the period, a total of 521 patients underwent surgery for lung cancer and there were 239 patients who matched the selection criteria. Survival and relapse data were obtained through reviewing the hospital records and contacting patients or their families. All surviving patients were contacted by way of March 2000. The duration of postoperative follow-up ranged from 12 to 105 month with a median period of 45 month The survival duration was measured from the date of surgery until the date of follow-up contact or death.

We routinely undertook bronchoscopy (transbronchial method) for a lung lesion that was suspicious of being lung cancer calm if it was tiny and existed peripherally. When a lesion could not be diagnosed employing bronchoscopy we undertook percutaneous needle aspiration cytology when the lesion was located peripherally. We used tumor excision for lesions that had not been diagnosed by way of percutaneous needle aspiration biopsy or were located at difficult regions for percutaneous needle aspiration technique. When the tumor was diagnosed as NSCLC residual surgery was undertaken in the same surgical step We used a single 22-gauge needle for needle aspiration cytology. We routinely examined the patients who had undergone surgery for lung cancer each 3 months for at least 5 years. At each attendance, chest radiography and children test analyses were undertaken. Pleural carcinomatosis was defined when chest radiography revealed a pleural effusion and malignant confined apartments were detected in it. When symptoms occurr which were suppos to be derived from cancer relapse, further examinations were undertaken. Dichotomous variables included sex histologic type of squamous solitary abode; squalid carcinoma or other types of lung cancer, pathologic stage, and whether the diagnostic order was by means of transpleural techniques or other techniques.

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