Do you want to puncture the lung nodule?Teach you to judge you

*For medical professionals for reading reference

Solution clinical confusion

With more and more patients with lung nodules and lung tumors, whether it is patients or our doctors, they will encounter such problems. Can we puncture before surgery and then decide whether to surgery? The diagnostic report of some hospital radiologists will also give a clear diagnosis of suggestions for puncture, and even some clinicians will actively go to puncture to confirm the diagnosis. When do you need to puncture? Generally speaking, patients with surgical indications do not recommend puncture. Those who have no surgical indications in the later stages or have no surgical indications, and the tumor is located on peripheral or bronchoscopy. We recommend actively puncture and confirm the diagnosis. Why? There are 3 reasons as follows:

First of all, let's take a look at the description of the textbook of the medical school "Surgery" (2019, 2019) of the Medical College: Regarding the lung splicing biopsy, lung splicing biopsy is not a pre -thoracic examination item. In Chapter 26, lung disease, section 3 of lung tumor, and second lung cancer (p. 268) about the method of helping to clarify the pathology: " ): For the lesions of the lungs, especially the masses close to the surrounding, conventional phlegm cellology or bronchial mirrors, which are difficult to diagnose diagnosis, you can consider TTNA. Suction biopsy may cause pneumothorax and bleeding, and a few may cause needle tract planting and metastasis. It is not recommended to puncture biopsy.

Secondly, the puncture biopsy does not necessarily get positive results, and negative does not rule out tumor diagnosis. Sometimes the puncture is obtained by the inflammatory response tissue or central necrosis tissue around the tumor, so it is not recommended to puncture biopsy. We encounter inflammation every year in clinical work every year, and patients who have been verified as lung cancer after surgery. Especially when the patient exists in multiple lung nodules, the puncture biopsy does not have a puncture material for all nodules. If one of the nodule puncture results are negative, the other nodule cannot be confirmed. Several nodules are different.

Finally, let's take a look at the Guide Suggestion of the clinical practice guide of NCCN non -small cell lung cancer in version 2021.7 in the United States:

① Patients who are highly clinically suspected of Phase I or phase II lung cancer (according to risk factors and imaging performance) do not require biopsy before surgery;

② Because biopsy increases time costs, costs and procedures, and does not affect treatment decision -making;

③ If the diagnosis of non -lung cancer is strongly doubtful, pre -surgery biopsy may be reasonable. If the diagnosis seems difficult or risk during surgery, the biopsy before the operation may be appropriate. Therefore, the suggestion of the NCCN guide is to strongly suspect that the diagnosis of non -lung cancer is strong, and the pre -operation biopsy may be reasonable.

references:

[1] Surgee, People's Health Publishing House 9th Edition March 9, 2019, 9th Edition 9

[2] 2021.7 NCCN non -small cell lung cancer clinical practice guide

The first release of this article: the medical world tumor channel

Author of this article: Kunming University of the First People's Hospital of Anning City, Kunming University of Technology, Kuncun Cao Ran

Editor in charge: Sweet

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