Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

Akthar, Adil S.; Ferguson, Mark K.; Koshy, Matthew; Vigneswaran, Wickii T.; Malik, Renuka

doi:10.1177/1533034615624045

Cited by 29 publications

(19 citation statements)

References 33 publications

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“…Current PET-CT and EBUS-TBNA examinations have limitations for detecting and estimating metastatic LNs of sub-centimeter size. 17,18 This study has some limitations. First, our study was restricted to metastasis of right lower lobe tumors to the LN in the right middle lobe.…”

Section: Discussionmentioning

confidence: 95%

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Blind spot in lung cancer lymph node metastasis: Cross‐lobe peripheral lymph node metastasis in early stage patients

Tan

et al. 2018

Thoracic Cancer

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BackgroundAt present, it has not yet been determined whether metastasis can be transferred cross‐lobe to peripheral lymph nodes (LNs) from other lobes in early stages of lung cancer, especially without any direct involvement to the pleura and parenchyma of the lobe. This study was conducted to investigate this issue.MethodsA retrospective analysis was conducted at the Chinese Academy of Medical Sciences. Patients undergoing right middle and lower lobectomy with lymphadenectomy for preoperative clinical stage Ia–IIIa from 2014 to 2015 were identified. To avoid interference, cases were limited to tumors within the primary lobe. When a tumor is completely located in the lower lobe, no direct invasion occurs into the visceral pleura/bronchus/parenchyma of the middle lobe and tumor cell metastasis into the peripheral LNs (stations 12–14) in the middle lobe is defined as cross‐lobe lymph node metastasis (CLM).ResultsA total of 68 patients were identified, of which nine (13.2%) had CLM. Seven had squamous cell carcinoma, one adenocarcinoma, and one small cell carcinoma. Seven cases (77.8%) had intermediate bronchus invasion, and seven cases (77.8%) intermediate bronchus adjacent lymph node involvement (station 11). Compared to non‐CLM patients, tumor diameter (5.2 vs. 3.2; P = 0.28), N2 lymph node metastasis rate (66.7% vs. 28.8%; P = 0.03), late stage (IIIa 77.8% vs. 35.6%; P = 0.04), and invasion of intermediate bronchus (77.8% vs. 45.8%; P = 0.07) relatively increased.ConclusionNon‐primary lobe peripheral LN metastasis exists in lung cancer and requires greater attention and further study.

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Section: Discussionmentioning

confidence: 95%

“…Metastasized LNs in the peripheral zone are much smaller than in the mediastinal zone, and most are < 0.5 cm. Current PET‐CT and EBUS‐TBNA examinations have limitations for detecting and estimating metastatic LNs of sub‐centimeter size …”

Section: Discussionmentioning

confidence: 99%

Blind spot in lung cancer lymph node metastasis: Cross‐lobe peripheral lymph node metastasis in early stage patients

Tan

et al. 2018

Thoracic Cancer

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“…The 5-year survival rate of NSCLC is only 7% (4). Moreover, lymph nodes and distant organ metastasis are the main reasons leading to treatment failure in NSCLC patients with radical resection (5,6).…”

Section: Introductionmentioning

confidence: 99%

Increased expression of monoamine oxidase A is associated with epithelial to mesenchymal transition and clinicopathological features in non-small cell lung cancer

Liu

et al. 2017

Oncol Lett

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Abstract. Monoamine oxidase A (MAOA), a mitochondrial enzyme, is closely associated with neurological disorders. Recently, MAOA has been linked to the progression of prostate cancer, hepatocellular carcinoma, and cholangiocarcinoma. However, MAOA was reported to have different effects on the progression of these types of cancer, and the role of MAOA in non-small cell lung cancer (NSCLC) progression remains unclear. The present study determined the expression of MAOA and epithelial to mesenchymal transition (EMT) markers in 45 pairs of NSCLC and matched non-tumor adjacent lung tissues, and further analyzed the correlation between MAOA expression and the EMT or the development of clinicopathological features. The results demonstrated that protein and mRNA expression levels of MAOA in NSCLC tissues were higher than those observed in the matched non-tumor adjacent lung tissues. Furthermore, the increased MAOA expression in NSCLC tissues was positively correlated with N-cadherin (r=0.525, P=0.002), Slug (r=0.515, P=0.001), and Twist (r=0.448, P= 0.008) expressions, but negatively correlated with E-cadherin expression (r=-0.387, P=0.01). Additionally, the elevated MAOA expression in NSCLC tissues was associated with late stage NSCLC (Z=-2.596, P=0.029) and lymph node metastases (Z=-2.378, P= 0.020). These findings suggest that MAOA may have a role in promoting NSCLC progression by mediating EMT. IntroductionLung cancer, the leading cause of cancer-related deaths worldwide, is commonly divided into two categories, small cell lung cancer (SCLC) and non-SCLC (NSCLC), depending on its degree of differentiation and morphological characteristics (1,2). NSCLC accounts for ~80% of primary lung cancers, including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma (3). The 5-year survival rate of NSCLC is only 7% (4). Moreover, lymph nodes and distant organ metastasis are the main reasons leading to treatment failure in NSCLC patients with radical resection (5,6).Epithelial to mesenchymal transition (EMT), a reversible biological process, is characterized by the loss of epithelial cell junction proteins (E-cadherin, Zo-1) (7,8), the gain of mesenchymal markers (vimentin, N-cadherin) (9,10), and the activation of transcription factors (Snail1, Slug, ZEB1, Twist) (11-15). Accumulating evidence indicates that EMT enhances tumor invasion, distant metastasis, and chemotherapy resistance in NSCLC, underscoring the need for a comprehensive understanding of the EMT function in NSCLC progression (16)(17)(18)(19).Monoamine oxidase A (MAOA), a mitochondria-bound enzyme, catalyzes the oxidative deamination of dietary amines and monoamine neurotransmitters, such as serotonin, norepinephrine, and dopamine (20,21). The functions of MAOA have been extensively studied in the context of neurological disorders, including mental depression, aggressive behaviors, and Parkinson's disease (22,23

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“…29,30 Because of the limited negative predictive value of positron emission tomography-computed tomography, especially in patients with T2 or central tumors, those patients treated with SBRT may undergo more detailed lymph node evaluation by minimally invasive or invasive staging techniques as N1 or N2 involvement. 31 Prospective trials evaluating the impact of invasive staging before SBRT are still running and should be awaited before changing standard practice.…”

Section: Bryan M Burt Mdmentioning

confidence: 99%

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

Gückenberger

Aerts

Schil

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Feature Editor's Note-After reading this Feature Expert Opinion, it should be more evident than ever that lobectomy is the current standard of care for patients with stage I non-small cell lung cancer (NSCLC) who are medically fit for operation. It is common, however, for fit patients with stage I NSCLC to perceive stereotactic body radiotherapy (SBRT) as an attractive option for the treatment of their disease. SBRT is a noninvasive, well-tolerated outpatient procedure, and the Internet is replete with favorable efficacy statistics for SBRT that cannot be appropriately interpreted without a certain background in the field. As is common with all new and exciting technologies, innovation is provided with an opportunity to outpace the standard of care. SBRT for NSCLC is a relatively young and rapidly evolving modality of radiotherapy that has shown favorable results for control of the localized tumor mass in patients with stage I lung cancer who are not candidates for surgery. Consideration of SBRT to treat patients with stage I NSCLC who are medically fit for operation has resulted in the launching of 3 randomized controlled clinical trials (ROSEL, STARS, ACOSOG Z4099) comparing lobectomy with SBRT for operable stage I NSCLC, each of which closed prematurely because of poor accrual. In the absence of randomized data, 2 bodies of lower-level evidence literature on the comparative efficacies of surgery and SBRT for stage I lung cancer have emerged, one from the surgical community and one from the radiation oncology community. Sampling articles from each side of the aisle is an educational exercise that will benefit the reader's understanding of the disparities in outcomes reporting between each discipline and their implications for interpretation of results. Recently, the American Society for Radiation Oncology (ASTRO) published a refreshing evidence-based guideline on the role of SBRT in early stage NSCLC that was endorsed by the American Society of Clinical Oncology (ASCO). According to these guidelines, SBRT is not recommended as an alternative to surgery for patients with stage I NSCLC and standard operative risk, outside the context of a clinical trial. The Feature Expert Opinion article that follows is an interdisciplinary collaboration of surgery, radiation oncology, and pulmonology that will prime the readers on the most salient aspects of the ASTRO and ASCO guidelines for SBRT and offers a practical perspective for implementing these guidelines into practice. Bryan M. Burt, MDWe have witnessed controversies within the thoracic oncology community about the optimal treatment of early-stage non-small cell lung cancer (NSCLC), for which surgical lobectomy is challenged by stereotactic body radiotherapy (SBRT), and in the absence of randomized controlled trials, thoracic surgeons and radiation oncologists interpreted the available data in different ways. Therefore, the American Society for Radiation Oncology generated an evidence-based guideline on the role of SBRT in early-stage NSCLC: This guideline was From the

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Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

Cited by 29 publications

References 33 publications

Blind spot in lung cancer lymph node metastasis: Cross‐lobe peripheral lymph node metastasis in early stage patients

Blind spot in lung cancer lymph node metastasis: Cross‐lobe peripheral lymph node metastasis in early stage patients

Increased expression of monoamine oxidase A is associated with epithelial to mesenchymal transition and clinicopathological features in non-small cell lung cancer

The American Society of Clinical Oncology–endorsed American Society for Radiation Oncology Evidence-Based Guideline of stereotactic body radiotherapy for early-stage non–small cell lung cancer: An expert opinion

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