Is the Risk of Pleural Seeding after Computed Tomography-Guided Needle Biopsy of a Lung Cancer That High? Our Results and Tips to Reduce the Occurrence

Educational Poster Background: Computed tomography-guided needle biopsy (CTNB) has been widely applied for obtaining a specimen before resection, especially in small lung nodules. However, an increased risk of tumor seeding has been reported, which does not correspond to our experience. At our single institute, 418 p-stage I lung cancers underwent CTNB before resection between October 2003 and December 2012. Procedures were performed following the same steps; briefly, an 18-gauge core biopsy needle was inserted into a lesion under CT-fluoroscopy; multiple penetrations of the pleura were avoided whenever possible (average 1.1 times/lesion); the insertion route was intentionally chosen to include some distance in the normal lung parenchyma. Forty-eight tumor recurrences were observed during the clinical follow-up (range 1–168 months, median 62 months). Among them, five cases developed either pleural- or chest wall-dominant recurrence. In contrast to some literature that reported high occurrence rates of the seeding, a lower rate of approximately 1% was observed in our case series. Tumor seeding caused by CTNB does not occur as frequently as it has been emphasized. Fewer times of pleural penetration and inclusion of the normal lung parenchyma in the insertion route are considered to contribute to a lower pleural seeding rate.

Publication History

Article published online:
26 April 2021