Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

Robinson, Eric M.; Ilonen, Ilkka; Tan, Kay See; Plodkowski, Andrew J.; Bott, Matthew; Bains, Manjit S.; Adusumilli, Prasad S.; Park, Bernard J.; Rusch, Valerie W.; Jones, David R.; Huang, James

doi:10.1016/j.athoracsur.2019.07.037

Cited by 23 publications

(15 citation statements)

References 30 publications

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“…This further confirms the prognostic value of CTR. Some studies have suggested that a solid component indicates invasive adenocarcinoma; 9,15 in our study, eight of 11 patients with lymph node metastasis had an acinar component of tumor growth. Based on ROC curve and sensitivity tests, we derived a cutoff value of 62% for CTR.…”

Section: Discussionsupporting

confidence: 53%

Preoperative consolidation‐to‐tumor ratio is effective in the prediction of lymph node metastasis in patients with pulmonary ground‐glass component nodules

et al. 2021

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Background Preoperative positron emission tomography/computed tomography (PET/CT) is recommended as a guideline for staging of lung cancer. However, for patients with pulmonary ground‐glass opacity (GGO) nodules who are supposed to have a relatively low risk of incidence of lymphatic metastasis, it remains uncertain whether PET/CT is more effective than consolidation‐to‐tumor ratio (CTR) in the prediction of regional lymphatic metastasis. Methods The data on patients who underwent surgery for lung cancer from 2011 to 2016 were collected retrospectively, which included CTR, results of PET/CT, and pathological characteristics. The patients who had undergone preoperative PET/CT were identified to find the risk factors for lymphatic metastasis. A receiver operating characteristic (ROC) curve and multiple logistic regression was utilized to clarify the predictive value of CTR and main tumor maximal standardized uptake value (SUVmax). Results Among 217 patients who had PET/CT before lobectomy, chest computed tomography revealed that 75 patients had CTR greater than 62%. The patients with lymphatic metastasis were shown to have higher CTR and higher main tumor SUVmax. Multiple logistic regression showed that younger age (<60 years), higher main tumor SUVmax on PET/CT, and greater CTR were independent predictive factors for lymphatic metastasis. The area under the ROC curve was comparable, 0.817 for CTR, and 0.816 for main tumor SUVmax. Conclusions The present study revealed that CTR was not inferior to main tumor SUVmax considering the predictive power for lymphatic metastasis preoperatively in lung cancer patients with a GGO component. PET/CT might not be necessary preoperatively in selected patients.

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Section: Discussionsupporting

confidence: 53%

Preoperative consolidation‐to‐tumor ratio is effective in the prediction of lymph node metastasis in patients with pulmonary ground‐glass component nodules

et al. 2021

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“…One study by Robinson et al [45] focused on staging in small peripheral tumors (<2 cm) and found occult pN1 and pN2 disease in 14 % and 3 % of patients (n = 58), respectively. Combined, they report a false-negative rate for clinical staging of 16 %.…”

Section: Discussionmentioning

confidence: 99%

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

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Lymph node staging in patients with non-small cell lung cancer is crucial for determining prognosis and treatment. Our objective was to evaluate the clinical-to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC and assess occurrence and distribution of occult lymph node metastases (OLM). Materials and methods: In a retrospective single center cohort study (n = 390), we analyzed all surgically treated NSCLC patients from January 2015 until April 2019. Patients were classified into subgroups (1) mediastinal staging by PET-CT/CT-scan (IMAGE-group) or (2) invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group). Agreement between final clinical (cN) and pathological nodal stage (pN) and the presence and location of OLM are analyzed. Results: Agreement between cN-and pN-stage was 86.3 % in the IMAGE-group (n = 117) and 50.9 % in the INVAS-group (n = 167). Occult N1 disease was found in 33 patients (16.6 % in cN0) of which 52 % occurred in LN-regions 12− 14. Occult N2 disease was found in 20 cases (6.5 % in cN0 and 12.7 % in cN1). Combined, 23.1 % of all pre-operatively cN0-staged patients (n = 46/199) had OLM (pN+), of which 12.1 % (24/199) had metastases in regions 5-6 and/or 12− 14. Of all patients with OLM, 50.0 % (23/46) had primary tumors ≤30 mm. Conclusion: OLM are frequently identified in clinically N0/N1 NSCLC, also in tumors <3 cm, and often in regions beyond reach of current staging techniques. These findings should be addressed when non-surgical treatment or sub-lobar resections are considered for early stage lung cancer.

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“…SABR (15) and RFA (16), which have also become alternative treatments for small-size NSCLC, might be more appropriate for elderly or inoperable patients than surgery. However, compared to standard lobectomy, sublobar resection and other alternatives might lead to a higher risk of recurrence and a worse survival (17); one reason for this difference might be attributed to occult LNM and micrometastasis, which were not rare in small-size NSCLC (7)(8)(9)(10)(11). According to studies from Shi et al (18) and Yu et al (19) the incidence rates of LNM in NSCLC ≤ 2 cm were up to 14.1 and 10.2%, respectively, which were similar to the result in our study (10.5%, 116/1,102).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, compared with those who underwent systematic LND, patients that received selective LND also presented a lower incidence of perioperative complications and similar survival (5,6). However, these sublevel surgical procedures would be more likely to cause tumor residual, since occult LNM occurred not rarely, even though in small-size NSCLC (7)(8)(9)(10)(11). Of possibly greater concern is the occurrence of micrometastases in histologically negative lymph nodes from early-stage NSCLC patients (10).…”

Section: Introductionmentioning

confidence: 99%

An Externally-Validated Dynamic Nomogram Based on Clinicopathological Characteristics for Evaluating the Risk of Lymph Node Metastasis in Small-Size Non-small Cell Lung Cancer

Han

Wang

et al. 2020

Front. Oncol.

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Background: Lymph node metastasis (LNM) status is of key importance for the decision-making on treatment and survival prediction. There is no reliable method to precisely evaluate the risk of LNM in NSCLC patients. This study aims to develop and validate a dynamic nomogram to evaluate the risk of LNM in small-size NSCLC. Methods: The NSCLC ≤ 2 cm patients who underwent initial pulmonary surgery were retrospectively reviewed and randomly divided into a training cohort and a validation cohort as a ratio of 7:3. The training cohort was used for the least absolute shrinkage and selection operator (LASSO) regression to select optimal variables. Based on variables selected, the logistic regression models were developed, and were compared by areas under the receiver operating characteristic curve (AUCs) and decision curve analysis (DCA). The optimal model was used to plot a dynamic nomogram for calculating the risk of LNM and was internally and externally well-validated by calibration curves. Results: LNM was observed in 12.0% (83/774) of the training cohort and 10.1% (33/328) of the validation cohort (P = 0.743). The optimal model was used to plot a nomogram with six variables incorporated, including tumor size, carcinoembryonic antigen, imaging density, pathological type (adenocarcinoma or non-adenocarcinoma), lymphovascular invasion, and pleural invasion. The nomogram model showed excellent discrimination (AUC = 0.895 vs. 0.931) and great calibration in both the training and validation cohorts. At the threshold probability of 0-0.8, our nomogram adds more net benefits than the treat-none and treat-all lines in the decision curve. Conclusions: This study firstly developed a cost-efficient dynamic nomogram to precisely and expediently evaluate the risk of LNM in small-size NSCLC and would be helpful for clinicians in decision-making.

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Prevalence of Occult Peribronchial N1 Nodal Metastasis in Peripheral Clinical N0 Small (≤2 cm) Non-Small Cell Lung Cancer

Cited by 23 publications

References 30 publications

Preoperative consolidation‐to‐tumor ratio is effective in the prediction of lymph node metastasis in patients with pulmonary ground‐glass component nodules

Preoperative consolidation‐to‐tumor ratio is effective in the prediction of lymph node metastasis in patients with pulmonary ground‐glass component nodules

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

An Externally-Validated Dynamic Nomogram Based on Clinicopathological Characteristics for Evaluating the Risk of Lymph Node Metastasis in Small-Size Non-small Cell Lung Cancer

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