We describe utilization, patients, and outcome of diagnostic lobectomy (DL) for suspected lung cancer without pathologic confirmation.
Retrospective review of consecutive lobectomy or bilobectomy for suspected or confirmed primary pulmonary malignancy was conducted using our participant’s sample of the Society of Thoracic Surgeons database (STS). Surgeons performed lobectomy based on clinical diagnosis or biopsy confirmation. Lung cancer confirmed by biopsy was compared to cases clinically suspected. Uni- and multivariate analyses identified variables associated with lobectomy without biopsy confirmation.
Among 2,651 lobectomies performed between 2006 and 2019 in 2,617 patients, lung cancer was either confirmed by preoperative biopsy in 51.6% (1368/2651) or clinically suspected before operation in 48.4% of cases (1283/2651). Intraoperative biopsy in 585 of 1283 cases (45.6%) proved lung cancer before lobectomy, while lobectomy proceeded in 698 cases (54.4%) without diagnosis. Final pathology proved lung cancer in 90% (628/698) without diagnosis before lobectomy and non-malignant disease in 10% (70/698). Non-neoplastic pathology included granulomas (30/70; 43%), pneumonia (12/70; 17%), bronchiectasis (7/70;10%) and other lesions (21/70; 30%). Operative mortality was 0.94% (25/2651) for the cohort and 1.0% (7/698) for diagnostic lobectomy only. Multivariate analysis identified patient age, type of lobectomy (right middle lobe) and the intermediate study tercile as associated with diagnostic lobectomy.
Lobectomy for suspected lung cancer without diagnosis is common, represents practice variation and infrequently (10% diagnostic, 2.6% all lobectomy) removes non-malignant disease. Tissue confirmation before lobectomy is preferred, particularly when operative risk is increased. Diagnostic lobectomy is acceptable in carefully selected patients and lesions.

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