Presentation (CTI)

OBJECTIVES: Lung biopsy is essential for lung cancer diagnosis, but its utilization varies based on clinical practices and technology availabilities. This study examines real-world biopsy use before lung resection and identifies factors influencing its administration.
METHODS: A retrospective analysis using Japan's Medical Data Vision database for lung resection patients (January 2008-September 2023) was conducted. Patients were categorized into Prior Biopsy (PB) and Non-Prior Biopsy (NPB) groups. Student t-tests, and chi-square tests were used to test the difference between PB and NPB group, and logistic regression was conducted to identify factors related to biopsy use.
RESULTS: Total of 37,102 patients were identified, PB (n = 17,956, 48.4%) and NPB (n = 19,146, 51.6%). PB had more males (62.2% vs. 58.1%, P<0.001), higher comorbidities (61.0% vs. 54.2%, P<0.001) and lower nonsmokers (37.1% vs. 41.5%, P<0.001). NPB had higher early-stage cancer (Stage I: 78.5% vs. 67.1%, P<0.001) and T1 cancer (54.5% vs. 71.9%, P<0.001). NPB had both longer mean days of first image to surgery (480.08 vs. 402.65, P<0.001) and first image to cancer confirmed (461.11 vs. 392.39, P<0.001). NPB underwent more wedge resection (22.7% vs. 8.0%, P<0.001), higher no prior lung cancer confirmed rate (39.5% vs. 18.5%, P<0.001) and post-operative benign diagnoses (2.23% vs. 0.71%, P<0.001). Significant predictors for biopsy included age >70 (OR: 1.43 [1.07-1.94]), COPD (OR: 1.06 [1.00-1.12]), Stage III cancer (OR: 1.71 [1.54-1.90]), neoadjuvant therapy (OR: 1.53 [1.30-1.80]), adjuvant therapy (OR: 1.79 [1.70-1.89]) and >=500 beds size hospital (OR: 2.94 [2.48,3.50]).
CONCLUSIONS: Prior biopsy enhances diagnostic accuracy and surgical planning, especially in patients with advanced-stage cancer or comorbidities. It improves pre- and post-operative diagnoses, highlighting the need for better diagnostic strategies in early-stage lung cancer detection.