TY - JOUR T1 - Which definition of central tumour is more predictive of occult mediastinal metastasis in non-small cell lung cancer patients with radiologic N0 disease? JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01508-2018 SP - 1801508 AU - Sun Hye Shin AU - Dong Young Jeong AU - Kyung Soo Lee AU - Jong Ho Cho AU - Yong Soo Choi AU - Kyungjong Lee AU - Sang-Won Um AU - Hojoong Kim AU - Byeong-Ho Jeong Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/01/02/13993003.01508-2018.abstract N2 - Background Guidelines recommend invasive mediastinal staging for centrally located tumours, even in radiologic N0 non-small cell lung cancer (NSCLC). However, there is no uniform definition of central tumour which is more predictive of occult mediastinal metastasis.Methods A total of 1337 consecutive patients with radiologic N0 disease underwent invasive mediastinal staging. Tumours were categorised into central and peripheral by seven different definitions.Results About 7% (93/1337) of patients had occult N2 disease, and they had significantly larger tumour size, and more solid tumours on computed tomography (CT). After adjustment for patient- and tumour-related characteristics, only the central tumour definition of inner one-third of the hemithorax by concentric lines arising from the midline significantly predicted occult N2 disease (aOR, 2.13; 95% CI, 1.17–3.87; p=0.013). This association was maintained after excluding patients with pure ground glass nodules (aOR, 2.54; 95% CI, 1.37–4.71; p=0.003) or only including those with solid tumours (aOR, 2.30; 95% CI, 1.08–4.88; p=0.030).Conclusions We suggest that central tumour should be defined using the inner one-third of the hemithorax adopted by drawing concentric lines from the midline. This is particularly useful for predicting occult N2 disease in patients with NSCLC.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Shin has nothing to disclose.Conflict of interest: Dr. Jeong has nothing to disclose.Conflict of interest: Dr. Lee has nothing to disclose.Conflict of interest: Dr. Cho has nothing to disclose.Conflict of interest: Dr. Choi has nothing to disclose.Conflict of interest: Dr. Lee has nothing to disclose.Conflict of interest: Dr. Um has nothing to disclose.Conflict of interest: Dr. Kim has nothing to disclose.Conflict of interest: Dr. Jeong has nothing to disclose. ER -