The Scan, the Needle or the Knife? National Trends in Diagnosing Stage I Lung Cancer
John F. Lazar1, Charles Bakhos1, Naomi Alpert2, Abbas Abbas1, Faiz Y. Bhora2, Emanuela Taioli2, Temple University Health System, Philadelphia, PA, USA1, Mount Sinai Medical Center, New York, NY, USA2
OBJECTIVE: Indeterminate lung nodules are increasingly discovered thanks to the widespread use of chest imaging for screening and other indications. The process to diagnosing which of these nodules is malignant varies based on protocols and preferences. The aim of this study is to analyze the factors associated with the different modalities used for diagnosing stage I non-small cell lung cancer (NSCLC).
METHODS: The National Cancer Data Base (NCDB) was queried for all patients with stage I NSCLC from 2004-2015. Four diagnostic modalities were identified; clinical radiographic alone (CRA), bronchial cytology (BC), needle biopsy (NB), or surgical biopsy (SB). A multivariate multinomial logistic regression estimating Odds Ratios (OR) and 95% Confidence intervals (CI) was used to assess the associations of patient demographics, cancer characteristics, and facility characteristics with these diagnostic modalities.
RESULTS: Of 250,614 patients; 4,233 (1.7%) had CRA, 5,226 (2.1%) had BC, 147,621 (59.9%) had NB and 93,534 (37.3%) had SB. Older patients were significantly more likely to receive a CRA and significantly less likely to have SB compared to those <50 years old (ORadj: 5.3 for 70-79 years). Patients more than 50 miles from facility were significantly more likely to undergo SB (ORadj: 1.25 vs NB; 1.30 vs CRA; 1.38 vs BC). Patients receiving SB had significantly shorter days from diagnosis to treatment (mean=23.0, vs. 53.5- 64.7 for other modalities, p<0001).
CONCLUSIONS: Diagnostic surgery to confirm early NSCLC was significantly associated with younger patients, greater travel distance, and shorter time to treatment compared to radiology, cytology or needle biopsy.