Intraoperative core needle biopsy under complete video-assisted thoracic surgery for indeterminate tumor of lung.

ABSTRACT

BACKGROUND: The accuracy, feasibility, and safety of intraoperative core needle biopsy under complete video-assisted thoracic surgery (VATS) (V-CNB) for indeterminate tumors are examined retrospectively, as well as the possibility of pleural dissemination. METHODS: The diagnostic yield and complications of V-CNB were evaluated for a total of 95 patients who underwent V-CNB for indeterminate tumor during the period of April 2002 through March 2012. Moreover, operation time, number of auto-suture instruments used for resection of the lung, and pleural dissemination were compared between the patients who underwent V-CNB (n = 44) and those who did not (n = 87, non-V-CNB) among stage I primary lung cancer patients, for whom lobectomy was performed under complete VATS during the same period. RESULTS: Of the 95 patients, eighty three had primary lung cancer, four had metastatic lung cancer, and eight had benign tumor. Sensitivity, specificity, and accuracy were 94.3, 87.5, and 93.7%, respectively. There were no complications associated with V-CNB. Among stage I primary lung cancer, for which lobectomy and lymph node dissection were performed, there was no significant difference between the V-CNB group and the non-V-CNB group for tumor size (23.5 and 24.7 mm, p = 0.482), distance between pleura and tumor (3.4 and 5.0 mm, p = 0.202), operation time (228 and 217 min, p = 0.186), and number of auto-suture instruments used for resection of the lung (4.77 and 4.61, p = 0.533). There was no pleural dissemination in the V-CNB group, although there were two cases (2.3%) in the non-V-CNB group. CONCLUSION: V-CNB diagnosed small-sized indeterminate lung tumors accurately during complete VATS operation, without any complications. V-CNB can reduce the use of auto-suture instruments necessary for performing wedge resection on frozen section diagnosis prior to lobectomy without increasing operation time and the risk of pleural dissemination.