TY - JOUR T1 - Centrally-located lung cancer and risk of occult nodal disease: an objective evaluation of multiple definitions of tumor centrality with a dedicated imaging software JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02220-2018 SP - 1802220 AU - Roberto F. Casal AU - Boris Sepesi AU - Ala-Eddin S. Sagar AU - Juerg Tschirren AU - Minxing Chen AU - Liang Li AU - Jennifer Sunny AU - Joyce Williams AU - Horiana B. Grosu AU - George A. Eapen AU - Carlos A. Jimenez AU - David E. Ost Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/02/13/13993003.02220-2018.abstract N2 - Introduction Current guidelines recommend invasive mediastinal staging in patients with centrally located radiographic stage T1N0M0 non-small cell lung cancer. The lack of a specific definition of central tumor has resulted in discrepancies among guidelines and heterogeneity in practice patterns.Methods Our objective was to study specific definitions of tumor centrality and their association with occult nodal disease. Pre-operative chest CT scans from patients with cT1N0M0 NSCLC were processed with a dedicated software that divides the lungs in thirds following vertical and concentric lines. This software accurately assigns tumors to a specific third based both on the location of the center of the tumor and its most medial aspect, creating 8 possible definitions of central tumors.Results 607 patients were included in our study. Surgery was performed for 596 tumors (98%). The overall pN disease was: 504 (83%) N0, 56 (9%) N1, 47 (8%) N2, and no N3. The prevalence of N2 disease remained relatively low regardless of tumor location. Central tumors were associated with upstaging from cN0 to any N (pN1, 2). Two definitions were associated with upstaging to any N: concentric lines, inner 1/3, center of the tumor (OR 3.91, 95% CI 1.85–8.26; p<0.001); and concentric lines, inner 2/3, most medial aspect of the tumor (OR 1.9, 95% CI 1.23–2.97; p=0.004).Conclusions We objectively identified two specific definitions of central tumors. While the rate of occult mediastinal disease was relatively low regardless of tumor location, central tumors were associated with upstaging from cN0 to any N.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. Casal reports grants from Siemens, grants from Concordia, personal fees from Olympus, personal fees from Boston Scientific, outside the submitted work.Conflict of interest: Dr. Sepesi has nothing to disclose.Conflict of interest: Dr. Sagar has nothing to disclose.Conflict of interest: Dr. Tschirren has nothing to disclose.Conflict of interest: Dr. Chen has nothing to disclose.Conflict of interest: Dr. Li has nothing to disclose.Conflict of interest: Dr. Sunny has nothing to disclose.Conflict of interest: Dr. Williams has nothing to disclose.Conflict of interest: Dr. Grosu has nothing to disclose.Conflict of interest: Dr. Eapen reports grants from Spiration, outside the submitted work.Conflict of interest: Dr. Jimenez reports grants from Care Fusion, outside the submitted work.Conflict of interest: Dr. Ost has nothing to disclose. ER -