Julie A Barta1, Claudia I Henschke2, Raja M Flores3, Rowena Yip2, David F Yankelevitz2, Charles A Powell4. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: charles.powell@mssm.edu.
Abstract
BACKGROUND: The rates of resection of nonmalignant lung nodules suspected preoperatively to be lung cancer vary widely and are reported to be as high as 40%. We determined the impact of the frequent use of computed tomography (CT)-guided fine needle aspiration (FNA) on the resection rate of nonmalignant nodules and frequency of resections of benign disease among patients undergoing evaluation for lung cancer resection operation in an academic medical center. METHODS: Eligible patients underwent CT-guided FNA, surgical resection, or both during the 12-month period between July 2013 and July 2014 for known or suspected first primary resectable stage I-III lung cancer. Patient data were extracted from the electronic medical records. RESULTS: One hundred ninety-seven patients underwent surgical resection; among them the overall resection rate of nonmalignant lesions was 13.1% (26/197). For those with preoperative FNA, the rate was 7.9% (11/139), and for those with no biopsy, the rate was 25.9% (15/58) (p = 0.001). The sensitivity and specificity of FNA biopsy were 96% and 98%, respectively. The false-negative rate was 3.9% (5/128). CONCLUSIONS: The resection rate of nonmalignant nodules was significantly lower for patients with preoperative CT-guided FNA biopsy than in those without. The diagnostic accuracy of FNA in these patients at moderate to high risk for lung cancer is higher than that of positron emission tomography, with a low rate of adverse events. These findings suggest that the frequent use of preoperative diagnostic confirmation by FNA results in a low rate of nonmalignant resection.
BACKGROUND: The rates of resection of nonmalignant lung nodules suspected preoperatively to be lung cancer vary widely and are reported to be as high as 40%. We determined the impact of the frequent use of computed tomography (CT)-guided fine needle aspiration (FNA) on the resection rate of nonmalignant nodules and frequency of resections of benign disease among patients undergoing evaluation for lung cancer resection operation in an academic medical center. METHODS: Eligible patients underwent CT-guided FNA, surgical resection, or both during the 12-month period between July 2013 and July 2014 for known or suspected first primary resectable stage I-III lung cancer. Patient data were extracted from the electronic medical records. RESULTS: One hundred ninety-seven patients underwent surgical resection; among them the overall resection rate of nonmalignant lesions was 13.1% (26/197). For those with preoperative FNA, the rate was 7.9% (11/139), and for those with no biopsy, the rate was 25.9% (15/58) (p = 0.001). The sensitivity and specificity of FNA biopsy were 96% and 98%, respectively. The false-negative rate was 3.9% (5/128). CONCLUSIONS: The resection rate of nonmalignant nodules was significantly lower for patients with preoperative CT-guided FNA biopsy than in those without. The diagnostic accuracy of FNA in these patients at moderate to high risk for lung cancer is higher than that of positron emission tomography, with a low rate of adverse events. These findings suggest that the frequent use of preoperative diagnostic confirmation by FNA results in a low rate of nonmalignant resection.
Authors: Raja Flores; Thomas Bauer; Ralph Aye; Shahriyour Andaz; Leslie Kohman; Barry Sheppard; William Mayfield; Richard Thurer; Michael Smith; Robert Korst; Michaela Straznicka; Fred Grannis; Harvey Pass; Cliff Connery; Rowena Yip; James P Smith; David Yankelevitz; Claudia Henschke; Nasser Altorki Journal: J Thorac Cardiovasc Surg Date: 2013-12-09 Impact factor: 5.209
Authors: James M Isbell; Stephen Deppen; Joe B Putnam; Jonathan C Nesbitt; Eric S Lambright; Aaron Dawes; Pierre P Massion; Theodore Speroff; David R Jones; Eric L Grogan Journal: Ann Thorac Surg Date: 2011-01 Impact factor: 4.330
Authors: Denise R Aberle; Amanda M Adams; Christine D Berg; William C Black; Jonathan D Clapp; Richard M Fagerstrom; Ilana F Gareen; Constantine Gatsonis; Pamela M Marcus; JoRean D Sicks Journal: N Engl J Med Date: 2011-06-29 Impact factor: 91.245
Authors: John K Field; Robert A Smith; Denise R Aberle; Matthijs Oudkerk; David R Baldwin; David Yankelevitz; Jesper Holst Pedersen; Scott James Swanson; William D Travis; Ignacio I Wisbuba; Masayuki Noguchi; Jim L Mulshine Journal: J Thorac Oncol Date: 2012-01 Impact factor: 15.609
Authors: Stephen A Deppen; William T Davis; Elizabeth A Green; Otis Rickman; Melinda C Aldrich; Sarah Fletcher; Joseph B Putnam; Eric L Grogan Journal: Ann Thorac Surg Date: 2014-07-31 Impact factor: 4.330
Authors: David O Wilson; Joel L Weissfeld; Carl R Fuhrman; Stephen N Fisher; Paula Balogh; Rodney J Landreneau; James D Luketich; Jill M Siegfried Journal: Am J Respir Crit Care Med Date: 2008-07-17 Impact factor: 21.405
Authors: Amelia W Maiga; Stephen A Deppen; Sarah Fletcher Mercaldo; Jeffrey D Blume; Chandler Montgomery; Laszlo T Vaszar; Christina Williamson; James M Isbell; Otis B Rickman; Rhonda Pinkerman; Eric S Lambright; Jonathan C Nesbitt; Eric L Grogan Journal: JAMA Surg Date: 2018-04-01 Impact factor: 14.766
Authors: Claudia I Henschke; Rowena Yip; Dorith Shaham; Javier J Zulueta; Samuel M Aguayo; Anthony P Reeves; Artit Jirapatnakul; Ricardo Avila; Drew Moghanaki; David F Yankelevitz Journal: J Thorac Imaging Date: 2021-01 Impact factor: 5.528