5 - Medical and surgical biopsies in pulmonary department at Alassad U. Hospital: focus on malignant tumors - 31/03/08

Introduction: Lung cancer is the leading cause of death amog patients with malignancy. Rates of lung cancer are changing. In most parts of the world, lung cancer rates have peaked among men and rates of all lung cancer types among women and adenocarcinoma among men continue to rise despite declining cigarette rates eventually. Medical or surgical biopsies are essential in the diagnosis of the disease. The effectiveness of biopsy technique and types of lung cancers are not well known in Syria. This study was designed to address these issues.

Purpose: This is the larger study that investigates all lung biopsies between 1/2003-02/2005 at our institution. This phase addresses all diagnostic invasive procedures done at Alassad U. Hospital.

Patients and methods: 1067 Surgical and medical procedures were performed at Alassad U. Hosp. between 1/2003-02/2005. These included 522 bronchoscopies (49%) with various biopsies, 204 CT-guided Bx and FNA (19%), 111 Pleural Bx (10.5%), and 230 surgical Bx (21.5%). 860 pts underwent medical and surgical lung biopsies; Of them, 708 pts (82% of total) underwent 931 biopsies (853 (91%) medical and 78 (9%) surgical).

152 pts (18%) underwent surgical diagnostic procedures only. Medical biopsies included bronchial (Endob.Bx, TBBx, TBNA), or CT-guided (CTB × CTNA) biopsies. Closed pleural biopsies were not included. Surgical biopsies included: open lung, pleurectomy, pleurescopy and mediastinoscopy.

Results: Medical biopsies (N=853) included bronchial biopsy (B.Bx) 42.5%, CT-guided biopsy (CT.G.Bx) 21.5%, Transbronchial biopsy (T.B.Bx) 18.3%, Pleural biopsy (P.Bx) 13%, Transbronchial needle aspiration (T.B.NA) 2.2%, CT-guided needle aspiration (CT.G.NA) 2.5%.

Surgical biopsies (N=230) included open lung Bx 7.66, Mediastinoscopy 11.3%, Pleurectomy 9.5%, Pleuroscopy Bx 2.6% Overall results of biopsies were: malignant tumors (N=384, 44.9%), benign tumors (N=13, 1.5%), benign nontumor conditions (N=463, 54%). Of malignant tumors, adenocarcinoma (33.3%) was the most frequent, followed by squamous cell carcinoma (31.7%), small cell carcinoma (12%), unspecified non-small cell carcinoma (12%), large cell carcinoma (1.3%), and finally bronchioloalveolar carcinoma (0.8%). Other malignancies included Hodgkin lymphoma (3.2%), NHL (1.2%), mesothelioma (1.8%), sarcoma (1.6%), metastasis (3.7%). Benign tumors included hamartoma (4), schwanoma (2), lipoma (3), neurofibroma (2), teratoma (1). Benign conditions included nonspecific inflammation (67%), tuberculosis (11%), normal (5%), sarcoidosis (2%). Other rare conditions were fibrosis, hydatid cysts, bronchiectasis, abscesses, empyema, BOOP, hemosiderosis, silicosis, histiocytosis X, mucormycosis, alveolar microlithiasis. Yield of the first procedure was as follow: B.Bx. 60%, TBBX 80%, TBNA, open lung Bx, and CTGBx 100%, pleural Bx 88%. Smoking history was positive in 71% of adenocarcinoma, 92% of Sq CC, 88% of small cell ca, 100% of LCC. Cough was the most frequent presenting symptoms (50%), followed by dyspnea (35%), weight loss (31%), and chest pain (30%). Cancer staging was nonsurgical (stage IIIB and IV) in 75% of all lung cancer. That included 75% of adenocarcinoma, 68% of squamous cell carcinoma, and 87% of small cell carcinoma.

Conclusion: Adenocarcinoma was the most common type of lung cancer seen. Rate of biopsy results were comparable to the results of other studies. Although smoking was the most common risk factor, it was not present in significant number of patients. This raises the concern about other risk factors such as environmental pollution. Unfortunately, most patients (74%) present at advanced non-surgical stage of cancer (IIIB or IV). More public awareness, smoking cessation programs and governmental procedures for air pollution are needed in order to decrease the rate of lung cancer or prevent its occurrence.