Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group

• Published in: Cirugia española (English ed.) Vol. 101; no. 6; pp. 408 - 416
• Main Authors: Lopez, Iker, Aguinagalde, Borja, Urreta, Iratxe, Royo, Iñigo, Bolufer, Sergio, Sanchez, Laura, Zabaleta, Jon, Fernández-Monge, Arantza, Recuero-Díaz, José Luis, Sesma, Julio, Amor, Sergio, Moradiellos, Francisco Javier, Arrarás, Miguel Jesús, Blanco, Ana Isabel, Boada, Marc, Sanchez, David, Cabañero, Alberto, Moreno, Nicolás, Cal, Isabel, Moreno, Ramón, Cilleruelo, Ángel, Crowley, Silvana, Gómez, David, Fernández, Elena, Hernando, Florentino, García, Santiago, López, Cipriano, García, María Dolores, García, Jose María, Rivo, José Eduardo, Garcia, Jose Alberto, Gelbenzu, Juan José, Ramírez, María Elena, Giraldo, Carlos Fernando, Mongil, Roberto, Gómez, María Teresa, Jiménez, Marcelo, Henández, Jorge, Fibla, Juan José, Illana, Jennifer D., Jauregui, Alberto, Jiménez, Unai, Rojo, Rafael, Martínez, Néstor J., Martínez, Elisabeth, Trujillo, Juan Carlos, Milla, Lucía, Moreno, Sergio B., Congregado, Miguel, Obiols, Carme, Call, Sergi, Quero, Florencio, Ramos, Ricard, Rodríguez, Alberto, Simón, Carlos María, Embun, Raul
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.06.2023
• Subjects: Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Computerised tomography; Cáncer pulmonar; Estadiaje ganglionar; Estadiaje mediastínico; Humans; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lung resection; Lymph node staging; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Mediastinal staging; Neoplasm Staging; Positron emission tomography; Prospective Studies; Resección pulmonar; Thoracic Surgery, Video-Assisted; Tomografía computarizada; Tomografía por emisión de positrones; Mediastinal staging; Estadiaje ganglionar; Lymph node staging; Lung resection; Cáncer pulmonar; Resección pulmonar; Lung cancer; Computerised tomography; Tomografía computarizada; Positron emission tomography; Estadiaje mediastínico; Tomografía por emisión de positrones
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2022.06.006

[Display omitted] The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44–0.79) and 0.71 (0.66–0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52–2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing. El objetivo del estudio es valorar el rendimiento diagnóstico de la tomografía computarizada (TC) y la tomografía por emisión de positrones (PET) en el estadiaje clínico mediastínico del cáncer pulmonar quirúrgico según los datos de la cohorte prospectiva del Grupo Español de Cirugía Torácica Videoasistida (GEVATS). Se han analizado 2.782 pacientes intervenidos por carcinoma pulmonar primario. Se ha estudiado el acierto diagnóstico en el estadiaje mediastínico (cN2). Se ha realizado un análisis bivariante y multivariante de los factores que influyen en el acierto. Se ha estudiado el riesgo de pN2 inesperado en los factores con los que se recomienda una prueba invasiva de estadiaje: cN1, tumor central o tamaño mayor de 3 cm. El acierto global de la TC y PET en conjunto es del 82,9% con VPP y VPN de 0,21 y 0,93. En tumores mayores de 3 cm y a mayor SUVmax del mediastino, el acierto es menor, OR de 0,59 (0,44–0,79) y 0,71 (0,66–0,75), respectivamente. En el abordaje VATS el acierto es mayor, OR de 2,04 (1,52–2,73). El riesgo de pN2 inesperado aumenta con el número de los factores cN1, tumor central o tamaño mayor de 3 cm: entre el 4,5% (0 factores) y 18,8% (3 factores), pero no hay diferencias significativas con la realización de prueba invasiva. La TC y PET en conjunto tienen un elevado valor predictivo negativo. Su acierto global es menor en tumores mayores de 3 cm y SUVmax del mediastino elevado, y mayor en el abordaje VATS. El riesgo de pN2 inesperado es mayor si cN1, tumor central o mayor de 3 cm y no varía significativamente con prueba invasiva.