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# Tumor seeding along the needle track after percutaneous lung biopsy

Authors:
ISSN 1806-3713
http://dx.doi.org/10.1590/S1806-37562016000000280
Tumor seeding along the needle track after
percutaneous lung biopsy
Leonardo Guedes Moreira Valle
1
, Rafael Dahmer Rocha
1
,
Guilherme Falleiros Mendes
1
, José Ernesto Succi
2
1
1. Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil.
2. Departamento de Cirurgia Torácica, Hospital Israelita Albert Einstein, Albert Einstein, São Paulo (SP) Brasil.
A 56-year-old male patient underwent percutaneous
biopsy of a nodule in the right lung apex (Figure 1A). The
tip of a 19-gauge coaxial needle was positioned in the
posterior chest wall (Figure 1B), and six samples of the
lesion were obtained with a 20-gauge core needle. The
pathological analysis revealed squamous cell carcinoma.
Using an anterior approach, we performed right upper
lobectomy with tumor-free margins. At 6 months of
follow-up, a positron emission tomography-CT scan of
the chest showed an
18
F- uorodeoxyglucose-avid soft
tissue mass (Figure 1C) in the T3-4 interspace, along
the biopsy tract, as well as bone erosion of the right
third rib posteriorly (Figure 1D), suggesting tumor
seeding. A subsequent CT scan of the chest, obtained
two months later, conrmed local disease progression.
We then performed en bloc resection with disease-free
pleural margins, and the pathological analysis conrmed
Tumor seeding along the biopsy route is exceedingly
rare. Certain factors, such as the use of large-bore
cutting needles, increase the risk of such tumor cell
dissemination, that risk also being greater when the
Kim JH, Kim YT, Lim HK, Kim YH, Sung SW. Management for chest wall
implantation of non-small cell lung cancer after ne-needle aspiration
biopsy; Eur J Cardiothorac Surg. 2003;23(5):828-32. http://dx.doi.
org/10.1016/S1010-7940(03)00095-2
Figure 1. Nodule in the right lung apex and percutaneous biopsy of the same: in A, positron emission tomography-CT
(PET-CT) scan showing the nodule (arrow); in B, CT scan showing the point of insertion of the coaxial needle (arrow); in C,
PET-CT scan after 6 months of follow-up, showing an
18
F-uorodeoxyglucose-avid soft tissue mass; and in D, CT scan after
6 months of follow-up, showing bone erosion of the right third rib posteriorly (arrow).
A
C
B
D
J Bras Pneumol. 2016;42(1):71-71
71
IMAGING IN PULMONARY
MEDICINE
... Surgical and pathologic processing of lung physical effects on lung tissue are sometimes inevitable. Tumor contamination of a needle biopsy with subsequent recurrence of the tumor along that biopsy path has been reported in lung cancer many times, [32][33][34][35] and if the tumor was then resected, pathologists might find STAS. Thunnissen et al. 36 illustrated 4 patterns of artifacts, one of which is tissue fragments and individual cells spreading through a knife surface (STAKS). ...
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... Tumor cell seeding after percutaneous needle biopsies can occur in various types of cancers [5,9,10]. In this study, we studied subcutaneously grown SKMEL2, a highly aggressive human melanoma xenograft, to test tumor seeding after core needle biopsy and the efficacy of GDS. ...
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Needle biopsy is an indispensable diagnostic tool in obtaining tumor tissue for diagnostic examination. Tumor cell seeding in the needle track during percutaneous needle biopsies has been reported for various types of cancers. The mechanical force of the biopsy both directly displaces the malignant cells and causes bleeding and fluid movement that can further disseminate cells. To prevent the risk of tumor cell seeding during biopsy, we developed a gelatin stick loaded with chemotherapeutics such as doxorubicin (DXR) that was inserted into the biopsy canal. The gelatin-doxorubicin sticks (GDSs) were created by passively loading precut gelatin foam strips (Gelfoam) with doxorubicin solution. The dried GDSs were inserted into the needle track through the sheath during the needle biopsy and eventually self-absorbed. We showed that this procedure prevented iatrogenic tumor seeding during needle biopsies in two subcutaneous tumor models. In an alternative application, using GDSs in intracranial brain tumor implantation avoided the outgrowth of tumor from the rodent brain, which could otherwise potentially fuse the tumor with the meninges and distort the results in therapeutic studies in rodent brain tumor models.
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The concept of loose tumor tissue fragments as a pattern of invasion in lung carcinoma has recently been proposed and is included in the 2015 WHO fascicle on the classification of lung tumors, so-called “spread through airs paces” or STAS. This inclusion is controversial, as there are significant data to support that this histologic finding represents an artifact of tissue handling and processing rather than a pattern of invasion. These data are summarized in this review. These data are summarized in this review and support the conclusion that the inclusion of STAS in the WHO classification for lung cancer as a pattern of invasion was premature and erroneous. In our opinion, these tumor cell clusters or loose cells appear to be simply an artifact, although one which may or may not pinpoint to a high-grade tumor with discohesive cells and adverse prognosis.
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