RT Journal Article
SR Electronic
T1 Centrally located lung cancer and risk of occult nodal disease: an objective evaluation of multiple definitions of tumour centrality with dedicated imaging software
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1802220
DO 10.1183/13993003.02220-2018
VO 53
IS 5
A1 Roberto F. Casal
A1 Boris Sepesi
A1 Ala-Eddin S. Sagar
A1 Juerg Tschirren
A1 Minxing Chen
A1 Liang Li
A1 Jennifer Sunny
A1 Joyce Williams
A1 Horiana B. Grosu
A1 George A. Eapen
A1 Carlos A. Jimenez
A1 David E. Ost
YR 2019
UL http://erj.ersjournals.com/content/53/5/1802220.abstract
AB Introduction Current guidelines recommend invasive mediastinal staging in patients with centrally located radiographic stage T1N0M0 nonsmall cell lung cancer (NSCLC). The lack of a specific definition of a central tumour has resulted in discrepancies among guidelines and heterogeneity in practice patterns.Methods Our objective was to study specific definitions of tumour centrality and their association with occult nodal disease. Pre-operative chest computed tomography scans from patients with clinical (c) T1N0M0 NSCLC were processed with a dedicated software system that divides the lungs in thirds following vertical and concentric lines. This software accurately assigns tumours to a specific third based both on the location of the centre of the tumour and its most medial aspect, creating eight possible definitions of central tumours.Results 607 patients were included in our study. Surgery was performed for 596 tumours (98%). The overall pathological (p) N disease was: 504 (83%) N0, 56 (9%) N1, 47 (8%) N2 and no N3. The prevalence of N2 disease remained relatively low regardless of tumour location. Central tumours were associated with upstaging from cN0 to any N (pN1/pN2). Two definitions were associated with upstaging to any N: concentric lines, inner one-third, centre of the tumour (OR 3.91, 95% CI 1.85–8.26; p<0.001) and concentric lines, inner two-thirds, most medial aspect of the tumour (OR 1.91, 95% CI 1.23–2.97; p=0.004).Conclusions We objectively identified two specific definitions of central tumours. While the rate of occult mediastinal disease was relatively low regardless of tumour location, central tumours were associated with upstaging from cN0 to any N.In T1N0M0 nonsmall cell lung cancer, the prevalence of occult mediastinal disease is low regardless of tumour location. However, centrally located tumours are at risk of upstaging to any N. Here, two specific definitions of central tumours are identified. http://ow.ly/pqa130nIokW