TY - JOUR T1 - Algorithm of preoperative N-staging of non-small cell lung cancer JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P451 AU - Andrey Petrov AU - Vadim Pischik AU - Marina Tlostanova AU - Mikhail Atyukov AU - Piotr Yablonsky Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P451.abstract N2 - Objectives: Accurate preoperative N-staging is a crucial point for management of non-small cell lung cancer (NSCLC). Aim of our study was to work out an algorithm of N-staging based not only on diagnostic value of different methods but also on long-term survival.Material and Methods: 365 patients with potentially resectable NSCLC were included in a prospective study from 2003 till 2009. Patients were divided into two groups according to preoperative staging: group 1 (n=190) where both videomediastinoscopy (VM) and non-invasive procedures (CT, PET, evaluation of CYFRA 21-1) were used and group 2 (n=175), where only non-invasive methods were included in N-staging plan. Patients without preoperatively proven N2/N3 (n=324) underwent lung resections with systematic lymph nodes dissection.Results:Specificity, sensitivity, accuracy, PPV and NPV of VM (100%, 76%, 92%, 100% 90%) were significantly higher than those of CT (66%, 57%, 63%, 43%, 78%). High NPV and accuracy of PET (89% and 83%) and CYFRA 21-1 (86% and 78%) allow to exclude mediastinal metastasis in patients with peripheral cancer. The rate of postoperative N2 was lower in group 1 than in group 2 (10% vs 27%, p<0,05). And postoperative 3- and 5-year survival was higher in group 1 than in group 2 (66%, 61% vs 49%, 45%; p<0,01). Based on these findings we arranged an algorithm of N-staging according to which VM could be omitted only in patients with CT N0-N1 peripheral cancer together with PET-negative mediastinum or together with squamous cell pathology and normal level of CYFRA 21-1.Conclusions: Proposed algorithm improves the accuracy of preoperative N-staging, that results in better long-term survival of operated patients. ER -