Clinicopathologic Factors Associated With Occult Lymph Node Metastasis in Patients With Clinically Diagnosed N0 Lung Adenocarcinoma

Moon, Youngkyu; Kim, Kyung Soo; Lee, Kyo Young; Sung, Sook Whan; Kim, Young Kyoon; Park, Jae Kil

doi:10.1016/j.athoracsur.2015.11.056

Cited by 52 publications

(61 citation statements)

References 29 publications

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“…Although the subtype of the tumour is not a micropapillary adenocarcinoma, it was reported that tumours with a micropapillary component (>5%) have a poorer prognosis than tumours without a micropapillary component (19,20). It was also reported that the micropapillary component is associated with lymph node metastasis, especially nodal upstaging after surgical resection (10,21). As GGO-predominant tumours contain no or few micropapillary components, they have relatively less risk factors for lymph node metastasis and recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…However, high nodal FDG uptake was discounted in the presence of benign calcification or if unenhanced CT images showed high attenuation with distinct margins. FDG uptake by mediastinal lymph nodes that was largely symmetric and equivocal on PET/CT scans was interpreted as inflammatory reactivity (9,10). Invasive mediastinal lymph node staging (i.e., mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration) was done only in the patients with positive lymph nodes as above.…”

Section: Radiologic Evaluation and Preoperative Stagingmentioning

confidence: 99%

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The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

Moon¹,

Lee²,

Park³

2017

J. Thorac. Dis.

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Background: Ground-glass opacity (GGO) on chest computed tomography (CT) is generally associated with non-invasive or minimally invasive adenocarcinoma (MIA). However, many instances of GGO are diagnosed as invasive adenocarcinoma. The purpose of this study is to analyse the histopathologic characteristics of invasive adenocarcinoma presenting as GGO and the prognosis after sublobar resection. Methods: We conducted a retrospective chart review of 191 patients who were treated for stage I nonsmall cell lung cancer presenting as a GGO-predominant tumour upon CT and who underwent curative resection. We analysed the histologic subtypes and components of invasive adenocarcinomas presenting as GGO-predominant tumours. We also compared the 5-year recurrence-free survival (RFS) of invasive adenocarcinomas presenting as GGO-predominant in patients undergoing sublobar resection or lobectomy. Results: Of 191 GGO-predominant tumour patients, 97 patients had adenocarcinoma in situ (AIS) or MIA, and 94 patients had invasive adenocarcinoma. In the analysis of the histologic component of invasive adenocarcinoma presenting as GGO, the mean rate of the lepidic component was 47.4%, that of the acinar component was 42.1%, and that of the papillary component was 7.3%. Micropapillary and solid components were nearly absent. The 5-year RFS rates of sublobar resection and lobectomy were both 100%. Conclusions: Invasive components such as acinar and papillary components can also be seen as GGO tumours on chest CT. After the sublobar resection of GGO-predominant tumours, a good prognosis can be expected, even if the tumour is an invasive adenocarcinoma such as the acinar or papillary subtypes.

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Section: Discussionmentioning

confidence: 99%

Section: Radiologic Evaluation and Preoperative Stagingmentioning

confidence: 99%

The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

Moon¹,

Lee²,

Park³

2017

J. Thorac. Dis.

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“…Performance of mediastinal lymph node evaluation (MLE) is recommended in most NSCLC, since occult lymph node metastasis may occur even in clinical N0 (9)(10)(11)(12). MLE methods include MLND and mediastinal lymph node sampling (MLS).…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

et al. 2016

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Background: The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC. Methods:We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.Results: Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% vs. 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987].GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.Conclusions: MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.

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“…Lobectomy with mediastinal lymph node dissection has been the standard surgical procedure for stage I non-small cell lung cancer (NSCLC) (2,3). However, according to the National Comprehensive Cancer Network (NCCN) guideline for NSCLC (Version 4.2016), sublobar resection can be adopted for cases with poor pulmonary reserve; other major comorbidity that contraindicates lobectomy; or a peripheral nodule of ≤2 cm with at least one of the following: (I) pure adenocarcinoma in situ (AIS) histology; (II) nodule with ≥50% ground glass opacity (GGO) on chest computed tomography (CT); (III) radiologic surveillance confirms a long doubling time.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

et al. 2016

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Background: Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. Methods: We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solidpredominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. Results: Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence.Conclusions: Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solidpredominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

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Clinicopathologic Factors Associated With Occult Lymph Node Metastasis in Patients With Clinically Diagnosed N0 Lung Adenocarcinoma

Cited by 52 publications

References 29 publications

The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

The prognosis of invasive adenocarcinoma presenting as ground-glass opacity on chest computed tomography after sublobar resection

The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

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