NSCLC Treatment Affected by Intraoperative Versus Preoperative Diagnosis

Preoperative tissue diagnosis of NSCLC is associated with increased lymph node harvest, upstaging rates, and adjuvant therapy compared with intraoperative diagnosis.

“It remains unclear if lack of preoperative tissue diagnosis influences likelihood of receipt of guideline-concordant care or postoperative outcomes,” Shale J. Mack, MD, explained.

Therefore, Mack and colleagues conducted a retrospective cohort analysis of more than 91,000 patients (median age, 69 years) with clinical stage I or II NSCLC who also underwent surgical resection from 2004 to 2018. Patients were found using the National Cancer Database.

The analysis showed that more patients received an NSCLC diagnosis preoperatively compared with patients diagnosed during definitive resection (57,811 vs 33,517, respectively). For patients with a preoperative diagnosis, the median time from diagnosis to surgery was 42 days.

Furthermore, preoperative diagnosis was associated with increased nodal sampling and nodal upstaging compared with intraoperative diagnosis.

The median tumor size was 1.7 cm for patients diagnosed intraoperatively versus 2.5 cm for patients diagnosed preoperatively. Intraoperative diagnosis also increased the likelihood of wedge resection compared with preoperative diagnosis (31.8% vs 13.2%, respectively). Wedge resection in patients with intraoperative diagnoses also meant less lymph node sampling.

In patients with positive lymph nodes, adjuvant chemotherapy was more common among those diagnosed preoperatively (9.8%) compared with intraoperatively (5.0%).