J Korean Med Sci.  2020 Jul;35(28):e261. 10.3346/jkms.2020.35.e261.

Efficacy and Cost-effectiveness of Surgical Biopsy for Histologic Diagnosis of Indeterminate Nodules Suspected for Early Stage Lung Cancer: Comparison with Percutaneous Needle Biopsy

• Na KJ
• Park IK
• Park S
• Kang CH
• Kim YT

• KMID: 2504368
• DOI: http://doi.org/10.3346/jkms.2020.35.e261

Abstract

Background
Indeterminate pulmonary nodules (IPN) suspected for early stage lung cancer mandate accurate diagnosis. Both percutaneous needle biopsy (PCNB) and surgical biopsy (SB) are valuable options. The present study aimed to compare the efficacy and cost-effectiveness between PCNB and SB for IPN suspected for early stage lung cancer.
Methods
During January–November 2018, patients who underwent operation for IPN suspected for early stage lung cancer (SB group, n = 245) or operation after PCNB (PCNB group, n = 113) were included. Patient-level cost data were extracted from medical bills from the institution. Propensity score matching was performed between the two groups from a retrospectively-collected database.
Results
Fifteen patients (11.5%) had complications after PCNB; thirteen (11.5%) were not confirmed to have lung cancer through PCNB but underwent operation for IPN. In SB group, 172 (70.2%) and 7 (2.9%) patients underwent wedge resection and segmentectomy for SB, respectively; 66 patients (26.9%) underwent direct lobectomy without SB. After propensity score matching, 58 paired samples were produced. Most patients in PCNB group were admitted twice (n = 55, 94.8%). The average hospital stay was longer in PCNB group (12.9 ± 5.3 vs. 7.3 ± 3.0, P < 0.001). Though the cost of the operation was comparable (USD 12,509 ± 2,909 vs. 12,669 ± 3,334; P = 0.782), the total cost was higher for PCNB group (USD 14,403 ± 3,085 vs. 12,669 ± 3,334; P = 0.006). The average subcategory cost, which increases proportional to hospital stay, was higher in PCNB group, whereas the cost of operation and surgical materials were comparable between the two groups.
Conclusion
Lung cancer operation following SB for IPN was associated with lesser cost, shorter hospital stays, and lesser admission time than lung cancer operation after PCNB. The increased cost and longer hospital stay appear largely related to the admission for PCNB.

Keyword

Percutaneous Needle Biopsy; Surgical Biopsy; Lung Cancer; Cost-effectiveness

Reference

1. Kramer BS, Berg CD, Aberle DR, Prorok PC. Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST). J Med Screen. 2011; 18(3):109–111. PMID: 22045816.

2. Kim YH, Lee KS, Primack SL, Kim H, Kwon OJ, Kim TS, et al. Small pulmonary nodules on CT accompanying surgically resectable lung cancer: likelihood of malignancy. J Thorac Imaging. 2002; 17(1):40–46. PMID: 11828211.

3. Shin KE, Lee KS, Yi CA, Chung MJ, Shin MH, Choi YH. Subcentimeter lung nodules stable for 2 years at LDCT: long-term follow-up using volumetry. Respirology. 2014; 19(6):921–928. PMID: 24934105.

4. Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS, et al. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol. 2002; 178(5):1053–1057. PMID: 11959700.

5. Li F, Sone S, Abe H, Macmahon H, Doi K. Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings. Radiology. 2004; 233(3):793–798. PMID: 15498895.

6. Lee SM, Park CM, Song YS, Kim H, Kim YT, Park YS, et al. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital. Eur Radiol. 2017; 27(12):5119–5126. PMID: 28656460.

7. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung AN, Mayo JR, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology. 2017; 284(1):228–243. PMID: 28240562.

8. Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl):e93S–e120S. PMID: 23649456.

9. Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 2015; 70 Suppl 2:ii1–ii54. PMID: 26082159.

10. Kim TJ, Lee JH, Lee CT, Jheon SH, Sung SW, Chung JH, et al. Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol. 2008; 190(1):234–239. PMID: 18094317.

11. Jeon JH, Kang CH, Kim HS, Seong YW, Park IK, Kim YT, et al. Video-assisted thoracoscopic lobectomy in non-small-cell lung cancer patients with chronic obstructive pulmonary disease is associated with lower pulmonary complications than open lobectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg. 2014; 45(4):640–645. PMID: 24052605.

12. Nwogu CE, D'Cunha J, Pang H, Gu L, Wang X, Richards WG, et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg. 2015; 99(2):399–405. PMID: 25499481.

13. Tsukada H, Satou T, Iwashima A, Souma T. Diagnostic accuracy of CT-guided automated needle biopsy of lung nodules. AJR Am J Roentgenol. 2000; 175(1):239–243. PMID: 10882279.

14. vanSonnenberg E, Casola G, Ho M, Neff CC, Varney RR, Wittich GR, et al. Difficult thoracic lesions: CT-guided biopsy experience in 150 cases. Radiology. 1988; 167(2):457–461. PMID: 3357956.

15. Choo JY, Park CM, Lee NK, Lee SM, Lee HJ, Goo JM. Percutaneous transthoracic needle biopsy of small (≤ 1 cm) lung nodules under C-arm cone-beam CT virtual navigation guidance. Eur Radiol. 2013; 23(3):712–719. PMID: 22976917.

16. Lorenz JM. Updates in percutaneous lung biopsy: new indications, techniques and controversies. Semin Intervent Radiol. 2012; 29(4):319–324. PMID: 24293806.

17. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol. 2017; 27(1):138–148. PMID: 27108299.

18. National Lung Screening Trial Research Team. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395–409. PMID: 21714641.

19. Jang SH, Sheen S, Kim HY, Yim HW, Park BY, Kim JW, et al. The Korean guideline for lung cancer screening. J Korean Med Assoc. 2015; 58(4):291–301.

20. Lee JW, Kim HY, Goo JM, Kim EY, Lee SJ, Kim TJ, et al. Radiological report of pilot study for the Korean Lung Cancer Screening (K-LUCAS) project: feasibility of implementing lung imaging reporting and data system. Korean J Radiol. 2018; 19(4):803–808. PMID: 29962887.

21. Fischbach F, Knollmann F, Griesshaber V, Freund T, Akkol E, Felix R. Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness. Eur Radiol. 2003; 13(10):2378–2383. PMID: 12743736.

22. Yanagawa M, Kusumoto M, Johkoh T, Noguchi M, Minami Y, Sakai F, et al. Radiologic-pathologic correlation of solid portions on thin-section CT images in lung adenocarcinoma: a multicenter study. Clin Lung Cancer. 2018; 19(3):e303–12. PMID: 29307591.

23. Ko JP, Suh J, Ibidapo O, Escalon JG, Li J, Pass H, et al. Lung adenocarcinoma: correlation of quantitative CT findings with pathologic findings. Radiology. 2016; 280(3):931–939. PMID: 27097236.