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Comparison of bronchoscopy and computed tomography-guided needle biopsy for re-biopsy in non-small cell lung cancer
Hirohisa Kano1, Toshio Kubo2, Kiichiro Ninomiya1
1Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
Background:
New therapeutic drugs have been developed for non-small cell lung cancer (NSCLC), and the prognosis of advanced NSCLC patients has improved. However, resistance to these drugs is a concern, and re-biopsy is necessary to determine the mechanism of drug resistance. There are many reports about the protocols for re-biopsy, including techniques such as bronchoscopy and computed tomography-guided needle biopsy (CTNB); however, there is no consensus on which method is optimal. Therefore, we retrospectively reviewed the bronchoscopy and CTNB re-biopsies conducted at our hospital.
Methods:
We retrospectively analyzed 79 cases of re-biopsies with bronchoscopy or CTNB in patients with NSCLC from January 2014 to December 2016 at our institute.
Results:
Forty-nine cases of bronchoscopy and 30 cases of CTNB were taken for re-biopsy. The diagnostic rates of bronchoscopy and CTNB were 83.7% and 100%, respectively (p = 0.023). The complication rates of bronchoscopy and CTNB were 18.4% and 36.7%, respectively (p = 0.11), with a statistically significant difference in the incidence of pneumothorax (0% vs. 23.3%, respectively; p < 0.01). Pneumothorax required drainage in 6.7% of all CTNB cases. There were no fatalities in either group.
Conclusions:
CTNB showed a higher diagnostic rate; however, it was associated with a higher rate of complications such as pneumothorax. Hence, the optimal modality must be determined individually for each patient.
Insights
Computed tomography-guided needle biopsy (CTNB) offers higher diagnostic rates for non-small cell lung cancer (NSCLC) re-biopsy. However, bronchoscopy may be preferred due to lower complication risks like pneumothorax.
Area of Science:
- Oncology
- Pulmonology
- Interventional Radiology
Background:
- Advanced non-small cell lung cancer (NSCLC) treatment has improved with new drugs.
- Drug resistance necessitates re-biopsy to identify resistance mechanisms.
- Optimal re-biopsy techniques (bronchoscopy vs. CTNB) for NSCLC remain debated.
Purpose of the Study:
- To compare the diagnostic rates and complication profiles of bronchoscopy and CTNB for NSCLC re-biopsy.
- To evaluate the safety and efficacy of different re-biopsy methods in NSCLC patients.
Main Methods:
- Retrospective analysis of 79 NSCLC re-biopsies (bronchoscopy or CTNB) from January 2014 to December 2016.
- Comparison of diagnostic yield and complication rates between the two procedures.
Main Results:
- CTNB achieved a 100% diagnostic rate compared to 83.7% for bronchoscopy (p=0.023).
- CTNB had a higher complication rate (36.7%) versus bronchoscopy (18.4%) (p=0.11).
- Pneumothorax occurred significantly more with CTNB (23.3%) than bronchoscopy (0%) (p<0.01), requiring drainage in 6.7% of CTNB cases.
Conclusions:
- CTNB offers superior diagnostic accuracy for NSCLC re-biopsy.
- Bronchoscopy presents a lower risk of complications, particularly pneumothorax.
- Individual patient factors should guide the choice between CTNB and bronchoscopy for NSCLC re-biopsy.
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