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H.W. Jeon



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    P1.12 - Poster Session 1 - NSCLC Early Stage (ID 203)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.12-013 - Limited resection for solid non small cell lung cancers provides worse outcome despite of clinical early stage. (ID 2137)

      09:30 - 16:30  |  Author(s): H.W. Jeon

      • Abstract

      Background
      In recent years, Limited resection for ground glass opacity lesions is not inferior to lobectomy. However, the effect of limited resection on solid type early lung cancer is controversial. The aim of this study was to compare clinical outcomes of patients with solid type early stage non small cell lung cancer undergoing limited resection or lobectomy.

      Methods
      This is a retrospective study between March 2000 and September 2010. the patients with ground glass opacity lesion were excluded. Medical records of 164 patients with clinical stage IA were reviewed. 31 patients underwent limited resection and 133 patients underwent Lobectomy Disease free survival and overall survival were estimated by Kaplan Meier methods Prognostic factors associated with disease free survival and overall survival were analyzed by the Cox proportional hazards model.

      Results
      Limited resection group had medical comobidities significantly including old age (p<0.001), cardiovascular disease (p=0.001) and lower diffusing capacity of the lung for carbon monoide (p<0.001). The lobectomy was associated with longer disease free survival and overall survival (p=0.001) By multivariate analysis, Sublobar resection (p=0.011), lymphatic vessel invasion (p=0.006), and number of positive lymph nodes (p=0.028) were predictors for survival. Sublobar resection (p<0.001), visceral pleural invasion (p=0.002), and lymphatic vessel invasion (p<0.001) were predictors for disease-free interval.

      Conclusion
      Solid-type lung cancers demonstrated aggressive behavior and there were numerous significant pathologic prognostic factors in clinical stage IA NSCLC from our study. Lymph node metastasis was not rare in clinical stage IA NSCLC with a solid component. Lobectomy with lymph node dissection remains the standard surgical procedure for patients with solid-type clinical stage IA NSCLC.

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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-027 - Intrapulmonary recurrence after computed tomography-guided percutaneous needle biopsy of stage I lung cancer (ID 2018)

      09:30 - 16:30  |  Author(s): H.W. Jeon

      • Abstract

      Background
      CT-guided percutaneous needle biopsy is a useful diagnostic procedure that is used for the evaluation of pulmonary nodules, and is regarded as a relatively safe procedure. Although tumor seeding along the biopsy needle tract after CT-guided percutaneous needle biopsy is an extremely rare complication with a reported incidence of 0.06% in Japan, it can lead to unnecessary procedures or fatal outcomes. Most of the reported cases of implantation metastasis after CT-guided percutaneous needle biopsy were about the tumor seeding, which occurred in the chest wall or the pleura; however, we present here a case of intrapulmonary recurrence after CT-guided percutaneous needle biopsy.

      Methods
      A 70-year-old woman was admitted to our hospital for the evaluation of a growing lung mass. She had undergone a thoracoscopic lobectomy of the right upper lobe 17 months ago, after CT-guided percutaneous needle biopsy, using a 22-gauge needle, which had confirmed the lung mass as an adenocarcinoma. She was discharged uneventfully and had been followed-up without additional treatment because there was no evidence of metastasis to the lymph nodes or to the distant organs. On the follow-up, a CT scan of the chest revealed a small lung nodule (0.5 cm in the longest diameter), which was located in the superior segment of the right lower lobe. Six months later, a repeat CT scan of the chest showed that the nodule had grown up to 1.2 cm.

      Results
      On admission, we performed successful CT-guided percutaneous needle biopsy of the lesion of the right lower lobe, and pathologic examination revealed an adenocarcinoma, which took the same characteristics as the previous diagnosis from the right upper lobe, which suggested a recurrence. We suspected implantation metastasis, and reviewed the previous biopsy procedures. Finally, we found that the biopsy needle had passed through the superior segment of the right lower lobe to target the right upper lobe lesion, and concluded that the new lesion might be an implantation metastasis, as a result of tumor seeding along the biopsy needle tract. She underwent segmentectomy of the superior segment of the right lower lobe, because there was no evidence of distant metastasis. She recovered well and was followed-up without additional treatment as before.

      Conclusion
      We present a case of implantation metastasis that occurred in the pulmonary parenchyma, after a CT-guided percutaneous needle biopsy of stage I lung cancer. We also present here a lesson from this case that the biopsy needle should not pass through different anatomical compartments other than the target compartment, and this strategy should be kept in mind, especially, when the lesion is located deeply.