Real-world diagnostic pathways and treatment patterns for suspected lung cancer in Japan: a nationwide claims...

Lung cancer (LC) poses significant diagnostic and therapeutic challenges, particularly regarding accurate and timely diagnosis. This study aimed to assess real-world diagnostic pathways and treatment patterns for suspected LC in Japan, identifying potential inefficiencies and areas for improvement.

A nationwide retrospective analysis was conducted using claims data from ∼28% of Diagnosis Procedure Combination hospitals in Japan, encompassing patients with suspected LC between 2008 and 2023. Diagnostic methods, biopsy utilization, treatment modalities, and intervals from suspicion to diagnosis and treatment initiation were analyzed.

Of the 757 397 patients studied (mean age 66.7 years; 56.0% male), 23.0% (n = 174 006) were confirmed to have LC. Diagnostic processes primarily relied on imaging, with biopsies carried out in only 21.2% of cases. Notably, 118 463 patients received LC diagnoses based solely on imaging findings without pathological confirmation, raising concerns about diagnostic accuracy. Surgical biopsies carried out before LC confirmation showed that 24% of benign conditions were identified. Bronchoscopy was frequently used, with increasing trends observed for advanced techniques like navigational bronchoscopy and cryobiopsy. Treatment initiation was relatively rapid, occurring a median of 14 days after suspicion and 9 days after confirmation. The primary treatments were surgery (35.4%), palliative care (28.1%), radiotherapy (19.6%), and drug therapy (16.8%).

Significant gaps were identified in LC diagnosis in Japan, including overreliance on imaging without sufficient biopsy validation and unnecessary invasive procedures. Improving biopsy utilization and adopting advanced bronchoscopic methods, alongside reconsidering current screening practices, could enhance diagnostic accuracy, patient outcomes, and resource efficiency.