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Ann Thorac Surg 2006;81:1182-1183
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

Departments of Cardiothoracic Surgery and Clinical Pathology, John Radcliffe Hospital, Headley Way, Oxford, 0X3 9DU United Kingdom

(Email: ravi.pillai{at}nds.ox.ac.uk).

To the Editor:

We would like to thank Dr Detterbeck [1] for his letter regarding the needle biopsy of thymomas prior to resection. Obtaining tissue for histologic analysis is essential in the management planning of thymomas. Indeed, histologic analysis of the tumor is not only essential to determine its grade, which affects the prognosis of the disease [2], but it is as important in analyzing the margins of the resection, the single most important factor determining the long-term patient survival after surgery [3]. As the majority of these tumors are localized and will be completely resected, histologic analysis of the resected tumor is advocated.

However, if tissue analysis is essential for the initial management of the tumor (in advanced stages of the disease or when a nonthymic tumor is highly suspected and therefore an adjuvant or nonsurgical therapy is indicated, or both), open surgical biopsy is the preferred method. It has a much better diagnostic rate, and the rate of complication associated with it is very low.

As Dr Detterbeck rightly stated in his extensive review [4], needle biopsy has a low diagnostic success rate (only 60%), and taking into consideration that the procedure is not morbidity-free in both the short-term and the long-term, all of this indicates that the usefulness of needle biopsy is debatable in the management of thymomas.

	References

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1. Detterbeck FC. Does an anecdote substantiate dogma? (letter) Ann Thorac Surg 2006;81:1182.[Free Full Text]
2. Chen G, Marx A, Wen-Hu C, et al. New WHO histologic classification predicts prognosis of thymic epithelial tumorsa clinicopathologic study of 200 thymoma cases from China. Cancer 2002;95(2):420-429.[Medline]
3. Regnard JF, Magdeleinat P, Dromer C, et al. Prognostic factors and long-term results after thymoma resectiona series of 307 patients. J Thorac Cardiovasc Surg 1996;112(2):376-384.[Abstract/Free Full Text]
4. Detterbeck FC, Parsons AM. Thymic tumors Ann Thorac Surg 2004;77(5):1860-1869.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hassan Kattach Ravi Pillai Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kattach, H. Articles by Pillai, R. Search for Related Content PubMed Articles by Kattach, H. Articles by Pillai, R. Related Collections Mediastinum Related Article