Comparison of Clinical and Surgical-Pathological Staging in IIIA Non-Small Cell Lung Cancer Patients

• Published in: Annals of surgical oncology Vol. 19; no. 1; pp. 89 - 93
• Main Authors: Muehling, Bernd, Wehrmann, Caren, Oberhuber, Alexander, Schelzig, Hubert, Barth, Thomas, Orend, Karl Heinz
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.01.2012; Springer Nature B.V
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Mediastinoscopy; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Neoplasm Staging; Oncology; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Surgery; Surgical Oncology; Thoracic Oncology; Tomography, X-Ray Computed; Early Tumor Stage; Clinical Staging; NSCLC Patient; UICC Stage; Mediastinal Lymph Node
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-011-1895-9

Background The heterogeneous group of IIIA NSCLC patients requires careful preoperative clinical staging as tumor size and lymph node involvement guide treatment. The purpose of our study was to analyze the correctness of clinical staging in IIIA patients. Methods Retrospective analysis of all patients resected due to lung cancer that had been staged IIIA either clinically using invasive and noninvasive techniques or surgical-pathologically after surgical resection. Correctness, sensitivity, specificity, and positive and negative predictive values of clinical staging were calculated. Results From our tumor database, 49 patients who met the inclusion criteria were identified. The histology of the primary tumor included adenocarcinoma (53%), squamous cell carcinoma (41%), and other (6%). Preoperative clinical staging consisted of computed tomography (CT), integrated positron emission tomography–CT (PET–CT), bronchoscopy, and mediastinoscopy. The predominant surgical procedures performed were lobectomies (57%) and pneumonectomies (29%). Clinical staging for UICC, T and N stage was correct in 36.7, 38.7, and 40.8%, respectively. In terms of T4 stage, sensitivity was 28.5%, specificity was 80.9%, positive predictive value was 20%, and negative predictive value was 87.1%. As for N2 involvement, we found a sensitivity of 66.6% and a specificity of 35.7%. Positive and negative predictive values for N2 involvement were 43.7 and 58.8% in that order. Conclusions Despite multimodal preoperative invasive and noninvasive staging techniques, the correctness of clinical staging in IIIA NSCLC patients is low. Hence, in doubt more invasive staging or probatory thoracotomy should be performed not to deny potentially curative surgery in those patients.