Abstract

Introduction

Hong et al determined, from 2394 patients with stage 1 lung cancer, that needle or intra-operative transthoracic biopsy had a higher risk for pleural recurrence.1 There was local concern that a straight to surgery approach advocated might not be sustainable and/or warranted.

Methods

An analysis of all Stage 1 lung cancers on Somerset cancer register was performed (Caldicott ref 3756). Exclusion criteria were mesothelioma and non-lung cancers.

Results

493 patients had stage 1 cancer (Jan 2013-Dec 2020). Data was insufficient in 34.169 patients had a positive CT guided or pre-operative biopsy: mean age 73 years (range 48-97) and 105 (60%) females. Diagnoses were predominantly 99 (57%) adenocarcinomas and 49 (28%) squamous cell cancers. Any recurrence occurred in 42 (24% vs 19% with Hong et al1) patients and concomitant ipsilateral pleural recurrence in 10 (6%-similar). Of those 10, 8 underwent CT guided biopsies, and 2 pre-operative biopsies, 8 were male, 2 female and 50% (5) were adenocarcinomas. 8 were solid tumours, and 6 had pleural contract. Lympho-vascular-pleural invasion was present in 6 of those 10 patients. Mean time to recurrence was 8.8 months (4-18) and mean time from recurrence to death 8.1 months (1-26). 210 patients had no biopsies, mean age was 77 years (49-99). Any recurrence occurred in 32 (15%); pleural recurrence in 2(1%), mean time 19 months. 2 patients in this group had treatment (surgery with incomplete excision).  Differences had no statistical significance. 

Conclusions

This single centre study in a predominantly Caucasian population replicates pleural recurrence rates from Hong et al. This data might inform local processes but larger studies are required.