Pathological complete necrosis after pulmonary thermal ablation: a systematic review and meta-analysis of ablate-and-resect studies.
Thermal ablation is increasingly used for pulmonary tumors, but treatment success is generally assessed by imaging rather than direct histopathology. Ablation-followed-by-resection studies provide direct evidence of residual viable tumor after ablation.
What is the rate of pathologically confirmed complete tumor necrosis after pulmonary thermal ablation, and which methodological or biological factors influence this outcome?
A systematic search of PubMed, Embase, and Web of Science (2005-2025) yielded 8 ablate-and-resect studies with 95 evaluable lesions. The primary analysis used a generalized linear mixed model (GLMM). The subgroups were sorted according to pathological assessment stringency, resection time, tumor type and ablation procedure.
The pooled complete necrosis rate was 71.4 % (95 % CI 40.1 %-90.3 %), with significant between-study heterogeneity (likelihood-ratio p < 0.0001) and a wide 95 % prediction interval (4.0 %-99.3 %). A Freeman-Tukey sensitivity analysis yielded a similar estimate of 69.0 %. Complete-necrosis rates varied numerically by pathological assessment (55.6 % vs 81.7 %), resection timing (61.1 % vs 79.7 %), tumor type (44.3 % vs 81.1 %), and ablation modality, but none of the subgroup differences was statistically significant.
Pathologic complete necrosis after pulmonary thermal ablation varies substantially across ablate-and-resect studies and is influenced by both treatment context and pathological assessment. The pooled estimate should therefore be interpreted as a descriptive summary of a heterogeneous evidence base rather than as a benchmark for contemporary definitive ablation.
What is the rate of pathologically confirmed complete tumor necrosis after pulmonary thermal ablation, and which methodological or biological factors influence this outcome?
A systematic search of PubMed, Embase, and Web of Science (2005-2025) yielded 8 ablate-and-resect studies with 95 evaluable lesions. The primary analysis used a generalized linear mixed model (GLMM). The subgroups were sorted according to pathological assessment stringency, resection time, tumor type and ablation procedure.
The pooled complete necrosis rate was 71.4 % (95 % CI 40.1 %-90.3 %), with significant between-study heterogeneity (likelihood-ratio p < 0.0001) and a wide 95 % prediction interval (4.0 %-99.3 %). A Freeman-Tukey sensitivity analysis yielded a similar estimate of 69.0 %. Complete-necrosis rates varied numerically by pathological assessment (55.6 % vs 81.7 %), resection timing (61.1 % vs 79.7 %), tumor type (44.3 % vs 81.1 %), and ablation modality, but none of the subgroup differences was statistically significant.
Pathologic complete necrosis after pulmonary thermal ablation varies substantially across ablate-and-resect studies and is influenced by both treatment context and pathological assessment. The pooled estimate should therefore be interpreted as a descriptive summary of a heterogeneous evidence base rather than as a benchmark for contemporary definitive ablation.
Authors
Zhao Zhao, Zhou Zhou, Nie Nie, Chen Chen, Wang Wang, Zhou Zhou, Han Han, He He
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