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Tumor seeding along the needle track after percutaneous lung biopsy

DOI:10.1590/S1806-37562016000000280
Authors:
Leonardo Guedes Moreira Valle at Hospital Israelita Albert Einstein
Leonardo Guedes Moreira Valle
Rafael Dahmer Rocha at Hospital Israelita Albert Einstein
Rafael Dahmer Rocha
Guilherme Falleiros Mendes at Hospital Israelita Albert Einstein
Guilherme Falleiros Mendes
Jose ernesto Succi at Universidade Federal de São Paulo
Jose ernesto Succi
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ISSN 1806-3713
© 2016 Sociedade Brasileira de Pneumologia e Tisiologia
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
, Juliano Ribeiro de Andrade
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
that tumor seeding had occurred.
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
tumor is an adenocarcinoma.
RECOMMENDED READING
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
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... 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). ...
Advances In Research Of Spreading Through Air Spaces And The Effects On The Prognosis Of Lung Cancer
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  • Nov 2019
Dandan Cao,1,2 Jun Sha,1,2 Rui Cui,1,2 Shuhua Han1 1Department of Pulmonary Medicine, Zhongda Hospital, School of Medicine, South-East University, Nanjing, Jiangsu, People’s Republic of China; 2Medicine Department of Southeast University, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Shuhua HanDepartment of Pulmonary Medicine, Zhongda Hospital, Ding Jia Qiao No. 87, Nanjing, Jiangsu 210009, People’s Republic of ChinaEmail hanshuhua0922@126.comAbstract: The concept of spread through air spaces (STAS) has been described as a new form of invasion in the lung in the 2015 WHO classification of Lung Tumors, namely invasion through alveolar spaces. STAS is a prognostic factor independent of growth pattern and tumor stage, and it is also an independent risk factor for unfavorable prognosis of stage I lung adenocarcinoma (ADC) and stage I lung squamous cell carcinoma (SCC). The pathological characteristics are different between ADC and SCC. STAS is not reported as routine, so setting a unified pathological reading standard, and hunting for STAS as a regular reading process is urgently advocated. We write this review to investigate the research progress of STAS and its effects on the prognosis of lung cancer.Keywords: lung cancer, STAS, pathological characteristics, prognosis
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Prevention of tumor seeding during needle biopsy by chemotherapeutic-releasing gelatin sticks
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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.
A Temperature-Controlled Laser Hot Needle With Grating Sensor for Liver Tissue Tract Ablation
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In this article, we proposed a laser hot needle for liver tissue tract ablation. The proposed laser hot needle is powered by a 4500-nm-diode laser incorporated with a closed-loop control system that comprises of a uniform fiber Bragg grating (FBG) temperature sensor and a computer. Based on the real-time feedback input from the FBG temperature sensor, the laser power is regulated by a proportional–integral–derivative (PID) control system to control the needle temperature. In the characterization test, a chirped grating-based distributed temperature sensor is employed for measuring the tissue temperature profile in the ex vivo bovine liver tissue during the ablation. A histological test is conducted to study the impact of tract ablation to the cellular structures of treated tissue and tissue coagulation. In a tract ablation test, a ~50-mm $\times \sim 6$ -mm (length $\times $ width) thermal denaturation zone has been created on ex vivo bovine liver tissue with the laser hot needle at 150 °C.
Needle track seeding in renal mass biopsies
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  • May 2019
A review and analysis of the literature demonstrates that needle track seeding in renal mass biopsy has been reported 16 times. This complication occurs almost exclusively among patients with papillary renal cell carcinoma. The incidence is associated with multiple punctures of the mass, the use of core needles of ≥20 gauge, and lack of a coaxial sheath. Needle tract seeding may be associated with tumor upstaging and a worse prognosis. Fine‐needle aspiration has a significantly lower rate of needle track seeding compared with large core needle biopsy (>20‐gauge needle). A more formalized risk‐based system for interpreting renal mass fine‐needle aspiration may be useful as clinicians choose among an increasing number of therapeutic options. Fine‐needle aspiration has a significantly lower rate of needle track seeding compared with large core (>20‐gauge) needle biopsy. A more formalized risk‐based system for interpreting renal mass fine‐needle aspiration specimens may be useful as clinicians choose among an increasing number of therapeutic options.
Comparison of computed tomography‐guided percutaneous needle biopsy and endobronchial biopsy in the diagnosis of multifocal pulmonary lesions
Article
Full-text available
  • May 2019
Background The retrospective study aimed to compare computed tomography (CT)‐guided percutaneous needle biopsy (PNB) and endobronchial biopsy (EB) in the diagnosis of multifocal pulmonary lesions with endobronchial involvement. Methods Between November 2014 and June 2017, consecutive patients who had underwent both CT‐guided PNB and EB via bronchoscopy for diagnosis of pulmonary lesions were evaluated retrospectively. Tissue samples were submitted for pathological examination, acid‐fast bacilli, TB RT‐PCR, and mycobacterial culture. Sensitivities of the two methods alone or in combination were calculated and compared using Fisher's exact test. Results Sixty‐seven patients (46 men and 21 women) were enrolled and could be diagnosed (32 malignant, 18 TB, and 17 benign). A final diagnosis of either malignant or TB diseases was made in 34 (68.0%) patients for CT‐guided PNBs, 19 (38.0%) patients for EBs, and 42 (84.0%) patients for the combination of both methods. Further statistical analysis showed significant difference in sensitivity between CT‐guided PNBs, or the combination of both methods, and EBs (all P < 0.05), and no difference between CT‐guided PNBs and the combination (P > 0.05). However, the combination of both methods appears to have the highest sensitivity in the detection of malignancies or TB diseases. Conclusion Compared with EB, CT‐guided PNB has a high diagnostic yield for the detection of TB and malignancy in patients with multifocal pulmonary lesions with endobronchial involvement. When the two biopsies are combined, it appears to provide an incremental diagnostic value for the pulmonary lesions.
Pulmonary loose tumor tissue fragments and spread through air spaces (STAS): Invasive pattern or artifact? A critical review
Article
  • Sep 2018
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.
Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy
Article
Full-text available
  • Jun 2003
The implantation of cancer cells in the chest wall after percutaneous needle biopsy of the lung is rare. We investigated the clinical outcomes of implantation metastasis after percutaneous fine-needle aspiration biopsy of pulmonary mass suggestive of lung cancer. Between January 1990 and December 2001, nine patients were treated for implantation metastasis of the chest wall. We retrospectively reviewed the patients' records and analyzed their clinical outcomes. During an 11-year period, 4365 patients underwent percutaneous fine-needle aspiration biopsy for indeterminate pulmonary nodule at Seoul National University Hospital. Eight patients developed implantation metastasis related to the procedure. One patient was presented to us after being biopsied in another hospital. A wide, full-thickness excision of the chest wall was performed in eight patients. In one patient, palliative chemotherapy was performed due to the presence of distant metastases in addition to the local recurrence. In six patients, postoperative adjuvant radiation was given. There was no surgical mortality or morbidity. The median survival was 96.5 months (range, 15-128 months) after pulmonary resection and 75 months (range, 8-93 months) after chest-wall resection. Six patients developed recurrence of the primary cancer in a median of 52 months (range 5-93 months). Three patients recurred at the chest-wall excision site and a wide, full-thickness chest-wall re-resection was performed for two patients who recurred only at the previous chest-wall excision site. Four patients are alive, four have died of recurrent disease, and one died of underlying lung disease. None died of implantation metastasis per se. The incidence of chest-wall implantation metastasis after fine-needle aspiration biopsy is extremely rare. With successful resection, the prognosis for the patient seems to depend on the primary cancer. A radical and wide resection in conjunction with irradiation may provide long-term survival in patients with an initial early stage cancer.