Access to biopsy services is a limiting factor to timely lung cancer diagnosis in many areas in the Philippines. On-site pathology evaluation allows for rapid diagnosis and helps ensure adequate specimen sampling. In our institution, its utilization and impact have not yet been evaluated.
We reviewed biopsy records of patients diagnosed with lung cancer in a tertiary teaching hospital in the Philippines from September 2017 to August 2019. For each procedure, we determined whether on-site pathology evaluation was performed. Furthermore, its association with the need for re-biopsy, time to cancer diagnosis, receipt of systemic treatment and time to treatment initiation was determined. We used the z test for two proportions to anlayze binary variables, and the Mann-Whitney U test for continuous variables.
A total of 112 pathology reports on 88 patients were reviewed. On-site evaluation was performed in 25 (22.3%) procedures (frozen section in 15, adequacy evaluation in 10). A re-biopsy was recommended in 37 procedures (33.0%) due to inadequate yield, of which only 24 (64.9%) were pursued. Patients who did not undergo on-site evaluation had a longer median time to cancer diagnosis (34 vs. 17 days, p = 0.04) and were more likely to require a re-biopsy (41% vs. 12%, p = 0.01). They were also less likely to eventually undergo systemic treatment (22.8% vs. 53.3%, p = 0.02), while a trend for a longer median time to treatment initiation did not reach statistical significance (145 vs. 83 days, p = 0.14). Among procedures where on-site evaluation was performed, there were only three instances when a repeat biopsy was recommended. In one case, the specimen was judged to be inadequate, but this was not followed by sampling of more tissue. In the other two cases, the specimen was deemed adequate but turned out to be insufficient for immunohistochemical evaluation.
On-site pathologic evaluation was associated with an earlier lung cancer diagnosis, a reduced need for a repeat biopsy, and a higher proportion of patients eventually receiving treatment. Efforts should be undertaken to increase the utilization of this service in order to optimize the quality of care for these patients.
The authors.
Has not received any funding.
R.E. King: Research grant/Funding (institution), Recipient of Pfizer Global Medical Grant: Pfizer. All other authors have declared no conflicts of interest.