Pathological complete necrosis after pulmonary thermal ablation: a systematic review and meta-analysis of ablate-and-resect studies.
Kaixin Zhao, Qiuxi Zhou, Xinming Nie et al.
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In 30 seconds
This systematic review and meta-analysis examined pathological complete tumor necrosis after pulmonary thermal ablation, using eight ablate-and-resect studies comprising 95 evaluable lesions. The pooled complete-necrosis rate was 71.4% (95% CI 40.1%-90.3%), but estimates varied substantially between studies, with a 95% prediction interval of 4.0%-99.3%. Rates differed numerically across pathological assessment methods, resection timing, tumor types, and ablation modalities, but no subgroup difference was statistically significant. The authors caution that the pooled estimate describes a heterogeneous evidence base and should not be treated as a benchmark for contemporary definitive ablation.
Key findings
- Across 95 lesions in eight studies, pooled pathological complete necrosis was 71.4% (95% CI 40.1%-90.3%).
- Between-study heterogeneity was significant (likelihood-ratio p < 0.0001), and the 95% prediction interval was 4.0%-99.3%.
- A Freeman-Tukey sensitivity analysis estimated complete necrosis at 69.0%.
- Subgroup rates varied numerically by assessment, timing, tumor type, and modality, but none of the differences was statistically significant.
Why it matters
Imaging-based assessment may not establish whether viable tumor remains after ablation, whereas resection studies provide direct pathological evidence. The wide prediction interval and variation across studies show that a single pooled necrosis rate may not represent outcomes in a particular treatment context. This distinction matters when interpreting pathological evidence alongside imaging-based measures of ablation success.
What to keep in mind
The evidence came from only eight ablate-and-resect studies and showed significant between-study heterogeneity; the pooled estimate had a wide prediction interval.