Preoperative biopsy does not affect postoperative outcomes of resectable non-small cell lung cancer

  • Yohei TaniguchiEmail author
  • Kento Fukumoto
  • Hiroshi Matsui
  • Tomohito Saito
  • Tomohiro Murakawa
Original Article



Preoperative diagnostic interventions such as transbronchial biopsy and/or computed tomography-guided biopsy inevitably disrupt the lung structures and may disseminate tumour cells into the airway, vessels, or pleural cavity. Therefore, these procedures may affect the postoperative outcomes. Thus, we aimed to compare the survival outcomes in patients diagnosed by transbronchial biopsy vs computed tomography-guided biopsy vs lung resection.


In a single-institution retrospective analysis, data from consecutive patients with cTanyN0M0 lung cancer, who underwent surgery between January 2006 and December 2012, were extracted by chart review. The overall and recurrence-free survivals of patients diagnosed by transbronchial biopsy, computed tomography-guided biopsy, and lung resection were compared using the univariate and multivariate Cox proportional hazard models. A stepwise backward elimination method, with a probability level of 0.15, was used to select the most powerful sets of outcome predictors.


Transbronchial biopsy and/or computed tomography-guided biopsy were performed for larger and more advanced tumours, than lung resection (intra- or postoperative-diagnosis group). At crude analysis, transbronchial biopsy group and computed tomography-guided biopsy group showed higher probability of pleural dissemination, and worse prognosis than the lung resection group. At multivariate analysis, the diagnostic methods were not identified as independent risk factors of pleural dissemination, overall survival, or recurrence-free survival.


Preoperative diagnostic interventions did not affect the relapse risk and prognosis, in this study cohort. Thus, preoperative diagnostic intervention is recommended if deemed necessary.


Preoperative diagnostic Transbronchial biopsy Computed tomography-guided biopsy Multivariate analysis Non-small cell lung cancer 



We thank Mr. Hideyuki Kozuka and Ms. Tomoko Hasegawa for their assistance in data collection and Mr. Tomoki Kitawaki and Mr. Takayuki Kawaura for their assistance in data-analysis.


None declared.

Compliance with ethical standards

Conflict of interest

All authors have no conflict of interest.


  1. 1.
    Alberg AJ, Ford JG, Samet JM. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines. Chest. 2007;132:29S–55S.CrossRefGoogle Scholar
  2. 2.
    Asano F, Aoe M, Ohsaki Y, Okada Y, Sasada S, Sato S, et al. Deaths and complications associated with respiratory endoscopy: a survey by the Japan Society for Respiratory Endoscopy in 2010. Respirology. 2012;17:478–85.CrossRefGoogle Scholar
  3. 3.
    Li H, Boiselle PM, Shepard JO, Trotman-Dickenson B, McLoud TC. Diagnostic accuracy and safety of CT-guided percutaneous needle aspiration biopsy of the lung: comparison of small and large pulmonary nodules. AJR. Am J Roentgenol. 1996;167:105–9.CrossRefGoogle Scholar
  4. 4.
    Nakajima J, Sato H, Takamoto S. Does preoperative transbronchial biopsy worsen the postsurgical prognosis of lung cancer? A propensity score-adjusted analysis. Chest. 2005;128:3512–8.CrossRefGoogle Scholar
  5. 5.
    Sawabata N, Maeda H, Ohta M, Hayakawa M. Operable non-small cell lung cancer diagnosed by transpleural techniques: do they affect relapse and prognosis? Chest. 2001;120:1595–8.CrossRefGoogle Scholar
  6. 6.
    Sobin LH, Gospodarowicz MK, Wittekind C. Lung and pleural tumours. TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell, 2009. pp. 138–46.Google Scholar
  7. 7.
    Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. Pathology and genetics of tumours of the lung, pleura, thymus and heart. In: Kleihues P, Sobin LH (eds) World Health Organization classification of tumours. Lyon: International Agency for Research on Cancer press; 2004. pp. 9–124.Google Scholar
  8. 8.
    Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2016;11:1204–23.CrossRefGoogle Scholar
  9. 9.
    Murakawa T, Konoeda C, Ito T, Inoue Y, Sano A, Nagayama K, et al. The ground glass opacity component can be eliminated from the T-factor assessment of lung adenocarcinoma. Eur J Cardiothorac Surg. 2013;43:925–32.CrossRefGoogle Scholar
  10. 10.
    Suzuki K, Yokose T, Yoshida J, Nishimura M, Takahashi K, Nagai K, et al. Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung. Ann Thorac Surg. 2000;69:893–7.CrossRefGoogle Scholar
  11. 11.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Prognostic significance of using solid versus whole tumor size on high-resolution computed tomography for predicting pathologic malignant grade of tumors in clinical stage IA lung adenocarcinoma: a multicenter study. J Thorac Cardiovasc Surg. 2012;143:607–12.CrossRefGoogle Scholar
  12. 12.
    Maeyashiki T, Suzuki K, Hattori A, Matsunaga T, Takamochi K, Oh S. The size of consolidation on thin-section computed tomography is a better predictor of survival than the maximum tumour dimension in resectable lung cancer. Eur J Cardiothorac Surg. 2013;43:915–8.CrossRefGoogle Scholar
  13. 13.
    Pinato DJ, Shiner RJ, Seckl MJ, Stebbing J, Sharma R, Mauri FA. Prognostic performance of inflammation-based prognostic indices in primary operable non-small cell lung cancer. Br J Cancer. 2014;110:1930–5.CrossRefGoogle Scholar
  14. 14.
    Gal AA. Use and abuse of lung biopsy. Adv Anat Pathol. 2005;12:195–202.CrossRefGoogle Scholar
  15. 15.
    Shields TW, LoCicero J, Reed CE, Feins RH. Chapter 15 Laboratory Investigations in the diagnosis of pulmonary diseases. In: Robinson PG. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2009. pp. 237–64.Google Scholar
  16. 16.
    Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143: e142S-e165S.Google Scholar
  17. 17.
    Gelbman BD1, Cham MD, Kim W, Libby DM, Smith JP, Port JL, et al. Radiographic and clinical characterization of false negative results from CT-guided needle biopsies of lung nodules. J Thorac Oncol. 2012; 7: 815–20.CrossRefGoogle Scholar
  18. 18.
    Kara M, Alver G, Sak SD, Kavukçu S. Implantation metastasis caused by fine needle aspiration biopsy following curative resection of stage IB non-small cell lung cancer. Eur J Cardiothorac Surg. 2001;20:868–70.CrossRefGoogle Scholar
  19. 19.
    Seyfer AE, Walsh DS, Graeber GM, Nuno IN, Eliasson AH. Chest wall implantation of lung cancer after thin-needle aspiration biopsy. Ann Thorac Surg. 1989;48:284–6.CrossRefGoogle Scholar
  20. 20.
    Voravud N, Shin DM, Dekmezian RH, Dimery I, Lee JS, Hong WK. Implantation metastasis of carcinoma after percutaneous fine-needle aspiration biopsy. Chest. 1992;102:313–5.CrossRefGoogle Scholar
  21. 21.
    Matsuoka T, Sonobe M, Date H. Intraoperative fine-needle aspiration biopsy (FNA) for lung cancer: diagnostic value and risk of Pleural dissemination. Surg Today. 2015;45:695–9.CrossRefGoogle Scholar
  22. 22.
    Inoue M, Honda O, Tomiyama N, Minami M, Sawabata N, Kadota Y, et al. Risk of pleural recurrence after computed tomographic-guided percutaneous needle biopsy in stage I lung cancer patients. Ann Thorac Surg. 2011;91:1066–71.CrossRefGoogle Scholar
  23. 23.
    Berger-Richardson D, Swallow CJ. Needle tract seeding after percutaneous biopsy of sarcoma: risk/benefit considerations. Cancer. 2017;123:560–7.CrossRefGoogle Scholar
  24. 24.
    Sawabata N, Funaki S, Hyakutake T, Shintani Y, Fujiwara A, Okumura M. Perioperative circulating tumor cells in surgical patients with non-small cell lung cancer: does surgical manipulation dislodge cancer cells thus allowing them to pass into the peripheral blood? Surg Today. 2016;46:1402–9.CrossRefGoogle Scholar
  25. 25.
    Shiono S, Ishii G, Nagai K, Yoshida J, Nishimura M, Murata Y. Histopathologic prognostic factors in resected colorectal lung metastases. Ann Thorac Surg. 2005;79:278–82.CrossRefGoogle Scholar
  26. 26.
    Sawabata N, Ohta M, Maeda H. Fine-needle aspiration cytologic technique for lung cancer has a high potential of malignant cell spread through the tract. Chest. 2000;118:936–9.CrossRefGoogle Scholar
  27. 27.
    Fidler IJ. The pathogenesis of cancer metastasis: the ‘seed and soil’ hypothesis revisited. Nat Rev Cancer. 2003;3:453–8.CrossRefGoogle Scholar
  28. 28.
    Johansson M, Denardo DG, Coussens LM. Polarized immune responses differentially regulate cancer development. Immunol Rev. 2008;222:145–54.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryKansai Medical UniversityHirakataJapan
  2. 2.Department of Thoracic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations