Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals

Borja Aguinagalde; Ion Ander Lizarbe; Juan Carlos Rumbero; Mónica Lorenzo; Leire Sanchez; Laura Sanchez; Arantza Fernández-Monge; Iker Lopez

doi:10.1093/ejcts/ezae136

Is histological confirmation necessary to avoid futile resections? Comparative of 4 university hospitals

Eur J Cardiothorac Surg. 2024 Mar 29;65(4):ezae136. doi: 10.1093/ejcts/ezae136.

Authors

Borja Aguinagalde^{1

2

3}, Ion Ander Lizarbe^{1

3}, Juan Carlos Rumbero⁴, Mónica Lorenzo⁴, Leire Sanchez⁵, Laura Sanchez⁶, Arantza Fernández-Monge^{1

3}, Iker Lopez^{1

3}

Affiliations

¹ Department of Thoracic Surgery, Osakidetza Basque Health Service, Donostia University Hospital, Donostia, Spain.
² Department of Surgery, UPV/EHU, Leioa, Spain.
³ Biogipuzkoa, Lung and Pleural Diseases Research Group, San Sebastian, Spain.
⁴ Department of Thoracic Surgery, Osakidetza Basque Health Service, Cruces University Hospital, Barakaldo, Spain.
⁵ Department of Thoracic Surgery, Catalan Health Institute, Vall d'Hebron Universtity Hospital, Barcelona, Spain.
⁶ Department of Thoracic Surgery, Cantabrian Health Service, Hospital Marqués de Valdecilla University Hospital, Santander, Spain.

PMID: 38632054
DOI: 10.1093/ejcts/ezae136

Abstract

Objectives: There is no consensus in the literature on preoperative histological analysis for lung cancer. The objective of this study was to assess 4 diagnostic models used in different hospitals with differing practices regarding preoperative histological diagnosis and the consequences in terms of unnecessary surgery and futile major resection.

Methods: We carried out a retrospective observational study collected from 4 university hospitals in Spain over 3 years (January 2019 to December 2021). We included all patients with a confirmed diagnosis of primary lung cancer and any patients with suspected primary lung cancer who had undergone surgery. All patients underwent computed tomography and positron emission tomography/computed tomography scans. Each multidisciplinary committee was free to choose whether to perform flexible bronchoscopic or transthoracic lung biopsy. Decisions concerning whether to perform intraoperative sample analysis, the surgical approach and the type of resection were left to the surgical team.

Results: We included a total of 1642 patients. The use of flexible endoscopy and its diagnostic performance varied substantially between hospitals (range: 23.8-79.3% and 25-60.7%, respectively); and the same was observed for transthoracic biopsy and its performance (range: 16.9-82.3% and 64.6-97%, respectively). Regarding major resection surgery (lobectomy or more extensive resection), the lowest rate was observed in hospital C (1%) and the highest in hospital B (2.8%), with between-hospital differences not reaching significance (P = 0.173).

Conclusions: The rate of histological sampling before lung cancer surgery still varies between hospitals. In spite of very diverse multidisciplinary management, the rate of futile lobectomy is not significantly higher in hospitals with lower rates of preoperative histological analysis.

Keywords: Lung cancer; Lung cancer diagnosis; Lung cancer surgery; Preoperative histological confirmation.