Tumor seeding along the needle track after percutaneous lung biopsy

1. Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil. 2. Departamento de Cirurgia Torácica, Hospital Israelita Albert Einstein, Albert Einstein, São Paulo (SP) Brasil. A 56-year-old male patient underwent percutaneous biopsy of a nodule in the right lung apex (Figure 1A). The tip of a 19-gauge coaxial needle was positioned in the posterior chest wall (Figure 1B), and six samples of the lesion were obtained with a 20-gauge core needle. The pathological analysis revealed squamous cell carcinoma. Using an anterior approach, we performed right upper lobectomy with tumor-free margins. At 6 months of follow-up, a positron emission tomography-CT scan of the chest showed an 18Ffluorodeoxyglucose-avid soft tissue mass (Figure 1C) in the T3-4 interspace, along the biopsy tract, as well as bone erosion of the right third rib posteriorly (Figure 1D), suggesting tumor seeding. A subsequent CT scan of the chest, obtained two months later, confirmed local disease progression. We then performed en bloc resection with disease-free pleural margins, and the pathological analysis confirmed that tumor seeding had occurred. Tumor seeding along the biopsy route is exceedingly rare. Certain factors, such as the use of large-bore cutting needles, increase the risk of such tumor cell dissemination, that risk also being greater when the tumor is an adenocarcinoma.