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Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer.
Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer.
- Source :
-
Journal of thoracic disease [J Thorac Dis] 2020 Dec; Vol. 12 (12), pp. 7156-7163. - Publication Year :
- 2020
-
Abstract
- Background: Appropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low.<br />Methods: We retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018.<br />Results: Three hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% vs. 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45-7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72-0.90) in central and 0.94 (95% CI: 0.90-0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% vs. 15.2%, P<0.001).<br />Conclusions: This study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.<br />Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1565). The authors have no conflicts of interest to declare.<br /> (2020 Journal of Thoracic Disease. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 2072-1439
- Volume :
- 12
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of thoracic disease
- Publication Type :
- Academic Journal
- Accession number :
- 33447404
- Full Text :
- https://doi.org/10.21037/jtd-20-1565