C110-05 Interventional Pulmonology or Interventional Radiology in the Diagnosis of Lung Cancer: A Snapshot From a Pre-Lung Cancer Screening Population

Abstract Rationale Lung cancer is the leading cause of cancer mortality worldwide, with an estimated 40% cases diagnosed at an incurable stage. The recently launched Australian National Lung Cancer Screening Program (NLCSP) and similar screening initiatives, are designed to facilitate earlier detection, enhancing the potential for curative intervention, leading to improved survival and quality of life. Suspected pulmonary malignancy may be diagnosed by either interventional pulmonology (IP) or interventional radiology (IR), with procedure choice determined by patient, lesional and local resource factors. In a population referred to a high-volume center for suspected lung malignancy in a pre-screening era, we aimed to characterize and compare demographics, diagnostic pathways, and biopsy procedure outcomes. Methods All IP and IR procedures performed for suspected lung malignancy at Royal Prince Alfred Hospital, Sydney, (July 2023-June 2024) were identified from a Bronchoscopy Registry (HREC:2023/PID02200). Demographic and procedural outcome data were analyzed and compared between procedures using Chi-square and Student’s t-tests. Diagnostic yield was determined from histopathological results and ≥6 months clinicoradiological follow-up. Results A total 206 patients median 67yrs (range 23-88), 60.2% male, BMI 26.9±5.9, ASA score 2 underwent 221 procedures IP: n = 134 (61%); IR: n = 87 (39%). A total 101 patients had primary lung cancer diagnoses. Of the whole cohort, 31 (15.0%) satisfied NLCSP criteria, and 60 (29.1%) satisfied US Preventive Services Task Force (USPSTF) criteria. Compared with those referred for initial IR evaluation, IP referrals were more likely to be male (69% vs 48%, p = 0.002), non-English speaking (31% vs 19%, p = 0.04), younger (65.5 vs 69.2yrs, p = 0.03), and have a lower ASA score (2 vs 3, p = 0.02). Referral to procedure time was similar (IP: 11.9 vs IR 12.7days, p = 0.6). IR referrals included a higher proportion of stage I lung cancer, figure 1 (40% vs 18%, p = 0.006). No significant differences in diagnostic yield (75% vs 78%, p = 0.56), adequacy for molecular studies (89% vs 84%, p = 0.52) and PDL1 (67% vs 82%, p = 0.11) between IP and IR procedures was observed. Requirement for second diagnostic and/or staging procedures was similar (IP: 14.6% vs IR: 14.3%, p = 0.95). Complications (eg pneumothorax) occurred in 6.2% versus 29.7% of IP and IR procedures, respectively (p 0.001). Conclusion In a pre-screening era population, a minority fulfilled lung cancer screening program criteria. IP and IR procedures had comparable diagnostic performance, with IP procedures demonstrating significantly lower complication rates. Referral pathway differentials in sex, age, primary language suggest system biases that require further evaluation in the present screening era. This abstract is funded by: None