CHEST Guidelines-Preoperative-Biopsy-Does-Not-Generate-STAS-

Preoperative-Biopsy-Does-Not-Generate-STAS-_chest

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The editorial discusses the findings of a study by Lee et al., which explores whether preoperative biopsy procedures like percutaneous needle biopsy (PCNB) and bronchoscopic biopsy contribute to spread through air spaces (STAS) in non-small cell lung cancer. STAS, defined as spreading of cancer cells through air spaces beyond the tumor, is associated with higher recurrence rates and poor prognosis, especially in sublobar resections.<br /><br />Lee et al. analyzed data from 2,169 patients with resected stage I lung cancer, 29.4% of whom were STAS-positive. While univariate analysis suggested a preliminary link between preoperative biopsy and STAS, multivariate analysis showed no significant association. Importantly, preoperative biopsy did not influence patient survival in both STAS-positive and STAS-negative cases, nor did it affect the prognosis of non-small cell lung cancer. <br /><br />The editorial emphasizes the significance of Lee et al.'s findings in dispelling concerns about preoperative biopsies potentially promoting STAS and impacting outcomes. The study indicates that preoperative biopsy can be conducted without increasing STAS-related risks in patients with early-stage lung cancer. This alleviates anxieties regarding biopsy-induced STAS.<br /><br />Despite these insights, unresolved questions remain about the biological mechanisms and clinical management of STAS. The study was limited to stage I cases, potentially missing insights on higher-stage disease where tumor seeding may occur. Additionally, more comprehensive data on intraoperative detection of STAS could enhance surgical decision-making, particularly concerning the extent of resection.<br /><br />In conclusion, Lee et al.'s study provides valuable evidence that preoperative biopsy does not elevate STAS risk, supporting its ongoing use in clinical diagnostics and easing concerns about its potential contribution to worse prognoses in early-stage lung cancer. Further research is necessary to explore STAS biology and improve treatment strategies.

Keywords

preoperative biopsy

percutaneous needle biopsy

bronchoscopic biopsy

spread through air spaces

STAS

non-small cell lung cancer

stage I lung cancer

patient survival

tumor seeding

surgical decision-making