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Van Schil PE, Asamura H, Nishimura KK, Rami-Porta R, Kim YT, Bertoglio P, Cangir AK, Donington J, Fang W, Giroux DJ, Lievens Y, Liu H, Lyons G, Sakai S, Travis WD, Ugalde P, Jeffrey Yang CF, Yotsukura M, Detterbeck F. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revisions of the T-Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2024; 19:749-765. [PMID: 38070600 PMCID: PMC11081813 DOI: 10.1016/j.jtho.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION An international database was created by the International Association for the Study of Lung Cancer to inform on the ninth edition of the TNM classification of lung cancer. The present analyses concern its T component. METHODS Data on 124,581 patients diagnosed with lung cancer from January 1, 2011 to December 31, 2019 were submitted to the International Association for the Study of Lung Cancer database. Of these, 33,982 met the inclusion criteria for the clinical T analysis, and 30,715 met the inclusion criteria for the pathologic postsurgical analysis. Survival was measured from the date of diagnosis or operation for clinically and pathologically staged tumors, respectively. T descriptors were evaluated in univariate analysis and multivariable Cox regression analysis adjusted for age, sex, pathologic type, and geographic region. RESULTS Comprehensive survival analysis revealed that the existing eighth edition T component criteria performed adequately in the ninth edition data set. Although pathologic chest wall or parietal pleura involvement (PL 3) yielded a worse survival compared with the other T3 descriptors, with a similar survival as T4 tumors, this difference was not observed for clinical chest wall or PL 3 tumors. Because of these inconsistent findings, no reallocation of chest wall or PL 3 tumors is advised. CONCLUSIONS The T subcommittee members proposed not to implement any changes and keep the current eighth-edition T descriptors for the ninth edition.
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
| | | | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Hui Liu
- Sun Yat-Sen University Cancer Center, Guangdong Sheng, People's Republic of China
| | - Gustavo Lyons
- Thoracic Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paula Ugalde
- Department of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Massachusetts
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
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Lin J, Li Y, Lin X, Che C. Decision-level data fusion based on laser-induced breakdown and Raman spectroscopy: A study of bimodal spectroscopy for diagnosis of lung cancer at different stages. Talanta 2024; 275:126194. [PMID: 38703481 DOI: 10.1016/j.talanta.2024.126194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
Lung cancer staging is crucial for personalized treatment and improved prognosis. We propose a novel bimodal diagnostic approach that integrates LIBS and Raman technologies into a single platform, enabling comprehensive tissue elemental and molecular analysis. This strategy identifies critical staging elements and molecular marker signatures of lung tumors. LIBS detects concentration patterns of elemental lines including Mg (I), Mg (II), Ca (I), Ca (II), Fe (I), and Cu (II). Concurrently, Raman spectroscopy identifies changes in molecular content, such as phenylalanine (1033 cm-1), tyrosine (1174 cm-1), tryptophan (1207 cm-1), amide III (1267 cm-1), and proteins (1126 cm-1 and 1447 cm-1), among others. The bimodal information is fused using a decision-level Bayesian fusion model, significantly enhancing the performance of the convolutional neural network architecture in classification algorithms, with an accuracy of 99.17 %, sensitivity of 99.17 %, and specificity of 99.88 %. This study provides a powerful new tool for the accurate staging and diagnosis of lung tumors.
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Affiliation(s)
- Jingjun Lin
- Changchun University of Technology, Changchun, Jilin, 130012, China
| | - Yao Li
- Changchun University of Technology, Changchun, Jilin, 130012, China
| | - Xiaomei Lin
- Changchun University of Technology, Changchun, Jilin, 130012, China.
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Recuero Díaz JL, Gatius Caldero S, Rosado Rodríguez J, Caamaño Villaverde V, Gómez de Antonio D, Tejerina E, Sánchez Moreno L, Martino González M, Moldes Rodríguez M, Abdulkader Nallib I, Ramírez Gil E, Amat Villegas I, Genovés Crespo M, García Ángel R, Sampedro Salinas C, Figueroa Almánzar S, Compañ Quilis A, Saumench Perramon R, González Pont G, Royo Crespo Í, Gambó Grasa P, García Fernández JL, Jiménez Heffernan JA, Cerón Navarro J, Prieto Rodríguez M, Porcel JM. Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer. Arch Bronconeumol 2024; 60:133-142. [PMID: 38238188 DOI: 10.1016/j.arbres.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). METHODS This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. RESULTS Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06-2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04-2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14-2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27-3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25-16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25-5.36, p<0.001). CONCLUSIONS Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.
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Affiliation(s)
- José Luis Recuero Díaz
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, IIS Aragón, Spain.
| | - Sonia Gatius Caldero
- Department of Pathology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | | | - David Gómez de Antonio
- Department of Thoracic Surgery, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Eva Tejerina
- Department of Pathology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Laura Sánchez Moreno
- Department of Thoracic Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Milagros Moldes Rodríguez
- Department of Thoracic Surgery, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ihab Abdulkader Nallib
- Department of Pathology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Elena Ramírez Gil
- Department of Thoracic Surgery, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Marta Genovés Crespo
- Department of Thoracic Surgery, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Rubén García Ángel
- Department of Pathology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cora Sampedro Salinas
- Department of Thoracic Surgery, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - Amparo Compañ Quilis
- Department of Pathology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Roser Saumench Perramon
- Department of Thoracic Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | | | - Íñigo Royo Crespo
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, IIS Aragón, Spain
| | - Paula Gambó Grasa
- Department of Pathology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - José Cerón Navarro
- Department of Thoracic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - José M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Hospital Universitario Arnau de Vilanova, Lleida, IRBLleida, Spain
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Cereser L, Cortiula F, Simiele C, Peruzzi V, Bortolot M, Tullio A, Como G, Zuiani C, Girometti R. Assessing the impact of structured reporting on learning how to report lung cancer staging CT: A triple cohort study on inexperienced readers. Eur J Radiol 2024; 171:111291. [PMID: 38218064 DOI: 10.1016/j.ejrad.2024.111291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE To assess the clinical utility of chest computed tomography (CT) reports for non-small-cell lung cancer (NSCLC) staging generated by inexperienced readers using structured reporting (SR) templates from the Royal College of Radiologists (RCR-SR) and the Italian Society of Medical and Interventional Radiology (SIRM-SR), compared to traditional non-systematic reports (NSR). METHODS In a cohort of 30 NSCLC patients, six third-year radiology residents reported CT examinations in two 2-month-apart separate sessions using NSR in the first and NSR, RCR-SR, or SIRM-SR in the second. Couples of expert radiologists and thoracic oncologists in consensus evaluated completeness, accuracy, and clarity. All the quality indicators were expressed on a 100-point scale. The Wilcoxon signed ranks, and Wilcoxon-Mann Whitney tests were used for statistical analyses. RESULTS Results showed significantly higher completeness for RCR-SR (90 %) and SIRM-SR (100 %) compared to NSR (70 %) in the second session (all p < 0.001). SIRM-SR demonstrated superior accuracy (70 % vs. 55 %, p < 0.001) over NSR, while RCR-SR and NSR accuracy did not significantly differ (60 % vs. 62.5 %, p = 0.06). In the second session, RCR-SR and SIRM-SR surpassed NSR in completeness, accuracy, and clarity (all p < 0.001, except p = 0.04 for accuracy between RCR-SR and NSR). SIRM-SR outperformed RCR-SR in completeness (100 % vs. 90 %, p < 0.001) and accuracy (70 % vs. 62.5 %, p = 0.002), with equivalent clarity (90 % for both, p = 0.27). CONCLUSIONS Inexperienced readers using RCR-SR and SIRM-SR demonstrated high-quality reporting, indicating their potential in radiology residency programs to enhance reporting skills for NSCLC staging and effective interaction with all the physicians involved in managing NSCLC patients.
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Affiliation(s)
- L Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - F Cortiula
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy; Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, The Netherlands.
| | - C Simiele
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - V Peruzzi
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - M Bortolot
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - A Tullio
- Institute of Hygiene and Evaluative Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Italy.
| | - G Como
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - C Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
| | - R Girometti
- Institute of Radiology, Department of Medicine, University of Udine, Italy.
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Samadzadeh Tabrizi N, Stout PA, Fabian T, Fabian T. The role of interventional bronchoscopy in the management of malignant central airway obstruction. Respir Med Case Rep 2024; 47:101984. [PMID: 38298452 PMCID: PMC10828452 DOI: 10.1016/j.rmcr.2024.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Nearly a third of patients with primary lung cancer present with malignant central airway obstruction (MCAO), and some of them appear to have advanced disease. In these patients, accurate staging is crucial. Although the literature extensively outlines the role of interventional bronchoscopy in palliation, its contribution to refining the staging of patients with MCAO is noteworthy. Here, we present a case of a patient initially diagnosed with stage IV cancer due to a left mainstem tumor causing complete lung collapse. He was referred to our institution for palliative treatment of his cough. Following interventional bronchoscopy, the patient's staging was revised to T1a, and subsequently, he underwent lobectomy without complications.
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Affiliation(s)
| | | | - Tyler Fabian
- Department of Thoracic Surgery, Albany Medical Center, Albany, NY, 12208, USA
| | - Thomas Fabian
- Department of Thoracic Surgery, Albany Medical Center, Albany, NY, 12208, USA
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Huang J, Osarogiagbon RU, Giroux DJ, Nishimura KK, Bille A, Cardillo G, Detterbeck F, Kernstine K, Kim HK, Lievens Y, Lim E, Marom E, Prosch H, Putora PM, Rami-Porta R, Rice D, Rocco G, Rusch VW, Opitz I, Vasquez FS, Van Schil P, Jeffrey Yang CF, Asamura H. The International Association for the Study of Lung Cancer Staging Project for Lung Cancer: Proposals for the Revision of the N Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2023:S1556-0864(23)02310-9. [PMID: 37866624 DOI: 10.1016/j.jtho.2023.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The accurate assessment of nodal (N) status is crucial to the management and prognostication of nonmetastatic NSCLC. We sought to determine whether the current N descriptors should be maintained or revised for the upcoming ninth edition of the international TNM lung cancer staging system. METHODS Data were assembled by the International Association for the Study of Lung Cancer on patients with NSCLC, detailing both clinical and pathologic N status, with information about anatomical location and individual station-level identification. Survival was calculated by the Kaplan-Meier method and prognostic groups were assessed by a Cox regression analysis. RESULTS Data for clinical N and pathologic N status were available in 45,032 and 35,009 patients, respectively. The current N0 to N3 descriptors for both clinical N and pathologic N categories reflect prognostically distinct groups. Furthermore, single-station N2 involvement (N2a) exhibited a better prognosis than multistation N2 involvement (N2b) in both clinical and pathologic classifications, and the differences between all neighboring nodal subcategories were highly significant. The prognostic differences between N2a and N2b were robust and consistent across resection status, histologic type, T category, and geographic region. CONCLUSIONS The current N descriptors should be maintained, with the addition of new subdescriptors to N2 for single-station involvement (N2a) and multiple-station involvement (N2b).
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Affiliation(s)
- James Huang
- Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Raymond U Osarogiagbon
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | | | | | - Andrea Bille
- Department of Thoracic Surgery, Guys Hospital, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, Kings College University, London, United Kingdom
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Kemp Kernstine
- Division of Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Eric Lim
- Imperial College London, London, United Kingdom; The Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - Edith Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland
| | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | - David Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Gaetano Rocco
- Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp University, Antwerp, Belgium
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
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Cai M, Zhao L, Zhang Y, Wu W, Jia L, Zhao J, Yang Q, Qiang Y. A progressive phased attention model fused histopathology image features and gene features for lung cancer staging prediction. Int J Comput Assist Radiol Surg 2023; 18:1857-1865. [PMID: 36943546 DOI: 10.1007/s11548-023-02844-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/19/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Identifying the stage of lung cancer accurately from histopathology images and gene is very important for the diagnosis and treatment of lung cancer. Despite the substantial progress achieved by existing methods, it remains challenging due to large intra-class variances, and a high degree of inter-class similarities. METHODS In this paper, we propose a phased Multimodal Multi-scale Attention Model (MMAM) that predicts lung cancer stages using histopathology image data and gene data. The model consists of two phases. In Phase1, we propose a Staining Difference Elimination Network (SDEN) to eliminate staining differences between different histopathology images, In Phase2, it utilizes the image feature extractor provided by Phase1 to extract image features, and sends the multi-scale image features together with gene features into our Adaptive Enhanced Attention Fusion (AEAF) module for multimodal multi-scale features fusion to enable prediction of lung cancer staging. RESULTS We evaluated the proposed MMAM on the TCGA lung cancer dataset, and achieved 88.51% AUC and 88.17% accuracy on classification prediction of lung cancer stages I, II, III, and IV. CONCLUSION The method can help doctors diagnose the stage of lung cancer patients and can benefit from multimodal data.
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Affiliation(s)
- Meiling Cai
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Lin Zhao
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Yanan Zhang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Wei Wu
- Department of Clinical Laboratory, Shanxi Provincial People's Hospital, Xi'an, China
| | - Liye Jia
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Juanjuan Zhao
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Qianqian Yang
- College of Information, Jinzhong College of Information, Jinzhong, China
| | - Yan Qiang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China.
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Lucena CM, Martin-Deleon R, Boada M, Marrades RM, Sánchez D, Sánchez M, Vollmer I, Martínez D, Fontana A, Reguart N, Molins L, Agustí C. Integral mediastinal staging in patients with NON-SMALL cell lung cancer and risk factors for occult N2 disease. Respir Med 2023; 208:107132. [PMID: 36720323 DOI: 10.1016/j.rmed.2023.107132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with non-small cell lung cancer (NSCLC), the presence of abnormal hiliar lymph nodes (clinical N1; cN1), central tumor location and/or tumor size (diameter >3 cm) increases the risk of occult mediastinal metastasis (OMM). This study investigates prospectively the diagnostic value of an integral mediastinal staging (IMS) strategy that combines EndoBronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) and Video-Assisted Mediastinoscopy (VAM) in patients with NSCLC at risk of OMM. METHODS Patients with NSCLC and radiologically normal mediastinum assessed non-invasively by positron emission tomography and computed tomography of the chest (PET-CT), and OMM risk factors (cN1, central tumor and/or >3 cm) underwent EBUS-TBNA followed by VAM if the former was negative. Those with negative IMS underwent resection surgery of the tumor. RESULTS EBUS-TBNA identified OMM in 2 out of the 49 patients evaluated (4%) and VAM in 1 of the 47 patients with negative EBUS (2%). Two patients with a negative IMS had OMM at surgery. Overall, the prevalence of OMM was 10%. EBUS-TBNA has a sensitivity of 40%, a negative predictive value (NPV) of 93.6%, and negative likelihood ratio of 0.60 (95%CI:0.30-1.16). The risk of not diagnosing OMM after EBUS was 6% and after IMS was 4.4%. CONCLUSION Integral mediastinal staging in patients with NSCLC and clinical risk factors for OMM, does not seem to provide added diagnostic value to that of EBUS-TBNA, except perhaps in patients with cN1 disease who deserve further research.
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Affiliation(s)
- Carmen M Lucena
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | | | - Marc Boada
- Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Ramon M Marrades
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - David Sánchez
- Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Ivan Vollmer
- Radiology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Daniel Martínez
- Pathology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Ainhoa Fontana
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Noemi Reguart
- Medical Oncology Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain; Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Laureano Molins
- Thoracic Surgery Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - Carlos Agustí
- Pulmonary Service, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain.
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Abstract
BACKGROUND The aim of this study was to evaluate the effect of prognostic factors and lymph node ratio (LNR) on survival in patients with resected non-small-cell lung cancer (NSCLC). METHODS Data from 421 patients with NSCLC who underwent complete resection between 2009 and 2015 were evaluated retrospectively. LNR was defined as the ratio of positive lymph nodes to the total number of lymph nodes removed. Associations between overall survival (OS) and LNR, node (N) status, and histopathologic status were evaluated. RESULTS The 5-year survival rate was 42.5% among all patients and 26.6% for patients aged 65 years or older. In the multivariate analysis, age ≥65 years, advanced-stage disease, non-squamous cell carcinomas, pN status, and having multiple-station pN2 and multiple-station pN1 disease were found to be poor prognostic factors (p < 0.05). There was no statistical difference in survival between patients with LNR (hazard ratio: 1.04, p = 0.45). CONCLUSION The results of our study indicate that pN stage, histopathologic type, pT stage, and geriatric age were the most important poor prognostic factors associated with survival after NSCLC resection. Although LNR is a factor associated with survival in gastrointestinal cancers, it did not impact survival in our study.
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Affiliation(s)
- Celal Bugra Sezen
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Cem Emrah Kalafat
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Vedat Doğru
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Volkan Erdogu
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Ozkan Saydam
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, Science of Health University, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey
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10
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Raymond C, Vieira A, Joubert P, Ugalde PA. Maximizing lymph node dissection from fresh lung cancer specimens. Eur J Cardiothorac Surg 2022; 63:6873746. [PMID: 36469356 DOI: 10.1093/ejcts/ezac554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Evaluation of lymph nodes during lung cancer resection is essential for pathologic staging and adjuvant treatment decisions. We developed a standardized approach for grossing resected lobes and segments to better assign the N1 category to hilar and peripheral lymph nodes. Lung specimens were dissected centrifugally from the bronchial stump, and all lymph nodes at the segmental and subsegmental bifurcations were removed. When combined with mediastinal lymph node dissection, this approach will likely maximize the number of lymph nodes analysed and improve the accuracy of pathologic N descriptor classification.
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Affiliation(s)
- Cédric Raymond
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Arthur Vieira
- Department of Thoracic Surgery, Centre Hospitalier Affilié Universitaire Régional, Université de Montreal, Trois-Rivières, QC, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, QC, Canada
| | - Paula A Ugalde
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, MA, USA
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11
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Poncelet AJ, Lacroix V. Lung cancer: is it node number or node station? Pardon me, but what is the question? Eur J Cardiothorac Surg 2022; 62:ezac397. [PMID: 35946536 DOI: 10.1093/ejcts/ezac397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 06/15/2023] Open
Affiliation(s)
- Alain Jean Poncelet
- Cardiovascular and Thoracic Surgery Department, Université Catholique de Louvain-Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Valérie Lacroix
- Cardiovascular and Thoracic Surgery Department, Université Catholique de Louvain-Cliniques Universitaires Saint-Luc, Brussels, Belgium
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12
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Nadkarni S, Karimundackal G, Jiwnani S, Tiwari VK, Niyogi D, Pramesh CS. Video-assisted mediastinoscopic lymphadenectomy (VAMLA): A video vignette. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34672142 DOI: 10.1510/mmcts.2021.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mediastinal staging in potentially resectable non-small cell lung cancer is of paramount importance since it impacts the survival of the patient. With increasing nodal stage, survival was noted to precipitously decline. Nodal status also determined the use of neoadjuvant/adjuvant therapy and other treatment modalities. Various methods of obtaining lymphatic tissue from the mediastinum for staging purposes have been described in the literature, although mediastinoscopic lymph node evaluation remains the gold standard. Endoscopic methods of mediastinal staging, like the endobronchial ultrasound guided and esophageal ultrasound guided fine-needle aspiration techniques, although minimally invasive, provide the highest levels of accuracy when used in conjunction with surgical mediastinal staging. Video-assisted mediastinoscopic lymphadenectomy (VAMLA) provides clear advantages, as far as ergonomics and training are concerned, over conventional mediastinoscopy. Access to stations 2R, 2L, 4R, 4L, and 7 is feasible with VAMLA. In this video vignette, we present the step-by-step technique of a standard VAMLA, with an overview of relevant anatomical relationships, for the effective and safe clearance of lymph node stations for the purposes of staging and defining appropriate therapy.
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Affiliation(s)
- Shravan Nadkarni
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - George Karimundackal
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sabita Jiwnani
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Virendra Kumar Tiwari
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Devayani Niyogi
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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13
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Zang X, Cheirsilp R, Byrnes PD, Kuhlengel TK, Abendroth C, Allen T, Mahraj R, Toth J, Bascom R, Higgins WE. Image-guided EBUS bronchoscopy system for lung-cancer staging. Inform Med Unlocked 2021; 25:100665. [PMID: 34532565 DOI: 10.1016/j.imu.2021.100665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses a device that integrates videobronchoscopy and an endobronchial ultrasound (EBUS) probe. To biopsy a lymph node, the physician first uses videobronchoscopy to navigate through the airways and then invokes EBUS to localize and biopsy the node. Unfortunately, this process proves difficult for many physicians, with the choice of biopsy site found by trial and error. We present a complete image-guided EBUS bronchoscopy system tailored to lymph-node staging. The system accepts a patient’s 3D chest CT scan, an optional PET scan, and the EBUS bronchoscope’s video sources as inputs. System workflow follows two phases: (1) procedure planning and (2) image-guided EBUS bronchoscopy. Procedure planning derives airway guidance routes that facilitate optimal EBUS scanning and nodal biopsy. During the live procedure, the system’s graphical display suggests a series of device maneuvers to perform and provides multimodal visual cues for locating suitable biopsy sites. To this end, the system exploits data fusion to drive a multimodal virtual bronchoscope and other visualization tools that lead the physician through the process of device navigation and localization. A retrospective lung-cancer patient study and follow-on prospective patient study, performed within the standard clinical workflow, demonstrate the system’s feasibility and functionality. For the prospective study, 60/60 selected lymph nodes (100%) were correctly localized using the system, and 30/33 biopsied nodes (91%) gave adequate tissue samples. Also, the mean procedure time including all user interactions was 6 min 43 s All of these measures improve upon benchmarks reported for other state-of-the-art systems and current practice. Overall, the system enabled safe, efficient EBUS-based localization and biopsy of lymph nodes.
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14
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Verhoeven RLJ, Leoncini F, Slotman J, de Korte C, Trisolini R, van der Heijden EHFM. Accuracy and Reproducibility of Endoscopic Ultrasound B-Mode Features for Observer-Based Lymph Nodal Malignancy Prediction. Respiration 2021; 100:1088-1096. [PMID: 34167125 DOI: 10.1159/000516505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic ultrasound routinely guides lymph node evaluation for the staging of a known or suspected lung cancer. Characteristics seen on B-mode imaging might help the observer decide on the lymph nodes of risk. The influence of nodal size on the predictivity of these characteristics and the agreement with which operators can combine these for malignancy risk prediction is to be determined. OBJECTIVES We evaluated (1) if prospectively scored individual B-mode ultrasound features predict malignancy when further divided by size and (2) assessed if observers were able to reproducibly agree on still lymph node image malignancy risk. METHODS Lymph nodes as visualized by EBUS were prospectively scored for B-mode characteristics. Still B-mode images were furthermore collected. After collection, a repeated scoring of a subset of lymph nodes was retrospectively performed (n = 11 observers). RESULTS Analysis of 490 lymph nodes revealed the short axis size is an objective measure for stratifying risk of malignancy (ROC area under the curve 0.78). With ≥8-mm size, 210/237 malignant lymph nodes were correctly identified (89% sensitivity, 46% specificity, 61% PPV, and 81% NPV). Secondary addition of B-mode features in <8-mm nodes had limited value. Retrospective analysis of intra- and interobserver scoring furthermore revealed significant disagreement. CONCLUSIONS Lymph nodes of ≥8-mm size and preferably even smaller should be aspirated regardless of other B-mode features. Observer disagreement in scoring both small and large lymph nodes suggests it is infeasible to include subjective features for stratification. Future research should focus on (integrating) other (semi)quantitative values for improving prediction.
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Affiliation(s)
- Roel L J Verhoeven
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fausto Leoncini
- Interventional Pulmonology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Jorik Slotman
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris de Korte
- Department of Radiology, Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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15
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Wu DY, de Hoyos A, Vo DT, Hwang H, Spangler AE, Seiler SJ. Clinical Non-Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals. Acad Radiol 2021; 28:753-766. [PMID: 32563559 DOI: 10.1016/j.acra.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/13/2020] [Accepted: 04/03/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Examine the accuracy of clinical non-small cell lung cancer staging and tumor length measurements, which are critical to prognosis and treatment planning. MATERIALS AND METHODS Compare clinical and pathological staging and lengths using 10,320 2016 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and 559 2010-2018 non-SEER single-institute surgically-treated cases, and analyze modifiable causes of disagreement. RESULTS The SEER clinical and pathological group-stages agree only 62.3% ± 0.9% over all stage categories. The lymph node N-stage agrees much better at 83.0% ± 1.0%, but the tumor length-location T-stage agrees only 57.7% ± 0.8% with approximately 29% of the cases having a greater pathology than clinical T-stage. Individual T-stage category agreements with respect to the number of pathology cases are Tis, T1a, T1b, T2a, T2b, T3, T4: 89.9% ± 10.0%; 78.7% ± 1.7%; 51.8% ± 1.9%; 46.1% ± 1.3%; 40.5% ± 3.1%; 44.1% ± 2.2%; 56.4% ± 4.7%, respectively. Most of the single-institute results statistically agree with SEER's. Excluding Tis cases, the mean difference in SEER tumor length is ∼1.18 ± 9.26 mm (confidence interval: 0.97-1.39 mm) with pathological lengths being longer than clinical lengths except for small tumors; the two measurements correlate well (Pearson-r >0.87, confidence interval: 0.86-0.87). Reasons for disagreement include the use of family-category descriptors (e.g., T1) instead of their subcategories (e.g., T1a and T1b), which worsens the T-stage agreement by over 15%. Disagreement is also associated with higher tumor grade, larger resected specimens, higher N-stage, patient age, and periodic biases in clinical and pathological tumor size measurements. CONCLUSIONS By including preliminary non-small cell lung cancer clinical stage values in their evaluation, diagnostic radiologists can improve the accuracy of staging and standardize tumor-size measurements, which improves patient care.
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Affiliation(s)
- Dolly Y Wu
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9248; California Institute of Technology, Pasadena, California.
| | | | - Dat T Vo
- Department of Radiation Oncology
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16
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Kuijvenhoven JC, Livi V, Szlubowski A, Ninaber M, Stöger JL, Widya RL, Bonta PI, Crombag LC, Braun J, van Boven WJ, Trisolini R, Korevaar DA, Annema JT. Endobronchial ultrasound for T4 staging in patients with resectable NSCLC. Lung Cancer 2021; 158:18-24. [PMID: 34098221 DOI: 10.1016/j.lungcan.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In lung cancer patients, accurate assessment of mediastinal and vascular tumor invasion (stage T4) is crucial for optimal treatment allocation and to prevent unnecessary thoracotomies. We assessed the diagnostic accuracy of linear endobronchial ultrasound (EBUS) for T4-status in patients with centrally located lung cancer. METHODS This is a retrospective study among consecutive patients who underwent EBUS for diagnosis and staging of lung cancer in four hospitals in The Netherlands (Amsterdam, Leiden), Italy (Bologna) and Poland (Zakopane) between 04-2012 and 04-2019. Patients were included if the primary tumor was detected by EBUS and subsequent surgical-pathological staging was performed, which served as the reference standard. T4-status was extracted from EBUS and pathology reports. Chest CT's were re-reviewed for T4-status. RESULTS 104 patients with lung cancer in whom EBUS detected the primary tumour, and who underwent subsequent surgical-pathological staging were included. 36 patients (35 %) had T4-status, based on vascular (n = 17), mediastinal (n = 15), both vascular and mediastinal (n = 3), or oesophageal invasion (n = 1). For EBUS, sensitivity, specificity, PPV and NPV for T4-status were (n = 104): 63.9 % (95 %CI 46.2-79.2 %), 92.6 % (83.7-97.6 %), 82.1 % (65.6-91.7 %), and 82.9 % (75.7-88.2 %), respectively. For chest CT (n = 72): 61.5 % (95 %CI 40.6-79.8 %), 37.0 % (23.2-52.5 %), 35.6 % (27.5-44.6 %), and 63.0 % (47.9-75.9 %), respectively. When combining CT and EBUS with concordant T4 status (n = 33): 90.9 % (95 %CI 58.7-99.8 %), 77.3 % (54.6-92.20 %), 66.7 % (47.5-81.6 %), and 94.4 % (721-99.1%), respectively. CONCLUSION Both EBUS and CT alone are inaccurate for assessing T4-status as standalone test. However, combining a negative EBUS with a negative CT may rule out T4-status with high certainty.
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Affiliation(s)
- Jolanda C Kuijvenhoven
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Vanina Livi
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Artur Szlubowski
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Maarten Ninaber
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Lauran Stöger
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Laurence C Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jerry Braun
- Department of Cardio-thoracic Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Willem Jan van Boven
- Department of Cardio-thoracic Surgery, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, the Netherlands.
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Abstract
Anatomic staging is a critical step in evaluation of patients with lung cancer. Accurate identification of stage based on features of primary tumor (T), regional nodes (N), and metastatic disease (M) is fundamental to determining appropriate care. In this article, the TNM components of the anatomic staging system and a framework for description of lung cancer with multiple pulmonary sites of involvement are discussed. TNM combinations are grouped according to prognosis, with patient-level, tumor-level, and environment-level factors also influencing survival outcomes. Although the staging system does not include molecular and immunologic information, anatomic staging remains the common language for communicating extent of disease.
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Affiliation(s)
- Lynn T Tanoue
- Yale School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520, USA.
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18
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de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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19
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Pajares V, Torrego A, Martínnez-Téllez E, Trujillo-Reyes JC. Diagnosis and invasive staging: Non-surgical invasive mediastinal staging. Endobronchial ultrasound. J Clin Transl Res 2020; 6:121-126. [PMID: 33521372 PMCID: PMC7837739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/10/2020] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED The diagnosis and staging of lung cancer are an important process that identifies treatment options and guides disease prognosis. Therefore, an accurate mediastinal lymph node (LN) staging is required not only to offer the appropriate treatment but also to avoid unnecessary invasive procedures. At present, endobronchial ultrasound (EBUS)-transbronchial needle aspiration is the preferred modality for sampling mediastinal lymph nodes because of its minimally invasive nature and high diagnostic yield. In this review, we discuss the utility of EBUS in mediastinal LN staging of non-small cell lung cancer (NSCLC). RELEVANCE FOR PATIENTS The use of EBUS-TBNA in the diagnosis of mediastinal and hilar LN pathology has become in an essential endoscopic technique and the first step for staging of lung cancer.
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Affiliation(s)
- Virginia Pajares
- 1Respiratory Medicine,2Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain,
Corresponding author: Virginia Pajares Ruiz Respiratory Medicine. Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Mª Claret, 167. CP: 08025, Barcelona, Spain Tel: +34935565972; Fax: +34935565601
| | - Alfons Torrego
- 1Respiratory Medicine,2Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
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20
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Kojima H, Terada Y, Yasuura Y, Konno H, Mizuno T, Isaka M, Funai K, Ohde Y. Prognostic impact of the number of involved lymph node stations in patients with completely resected non-small cell lung cancer: a proposal for future revisions of the N classification. Gen Thorac Cardiovasc Surg 2020; 68:1298-1304. [PMID: 32449108 DOI: 10.1007/s11748-020-01389-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The current nodal staging for lung cancer is defined only by the anatomical site of metastasis. However, the International Association for the Study of Lung Cancer (IASLC) proposed further subdivisions of the N descriptor that considers the locations and numbers of involved lymph node stations. This study aimed to test the new IASLC categories and compare their prognostic abilities to those of our proposed model that considers only the number of involved lymph node stations instead of the sites of metastasis. METHODS Between September 2002 and December 2016, 1581 patients who underwent complete resection for pathologically diagnosed Tis-4N0-2M0 non-small cell lung cancer were retrospectively analyzed. We evaluated the survival rates according to the patients' N classification as recently proposed by the IASLC and by the number of involved lymph node stations, and determined the optimal N classification. RESULTS The 5-year survival rates for patients with IASLC stages N1a, N1b, N2a1, N2a2, and N2b were 71.5%, 49.9%, 73.7%, 62.1%, and 46.9%, respectively. These results showed relatively good categorizations; however, some prognostic overlaps existed and not all differences were significant. After redefining the number of involved stations as Nα for 1, Nβ for 2-3, and Nγ for ≥ 4 without considering the metastasis sites, the 5-year survival rates for patients in these categories were 72.1%, 58.3%, and 29.6%, respectively; the differences between them were significant. CONCLUSION The number of involved lymph node stations is a more accurate prognostic indicator in patients with completely resected non-small cell lung cancer.
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Affiliation(s)
- Hideaki Kojima
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
| | - Yukihiro Terada
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yoshiyuki Yasuura
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hayato Konno
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tetsuya Mizuno
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yasuhisa Ohde
- Division of Thoracic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Hwang JK, Page BJ, Flynn D, Passmore L, McCaul E, Brady J, Yang IA, Marshall H, Windsor M, Bowman RV, Naidoo R, Guan T, Philpot S, Blake ME, Fong KM. Validation of the Eighth Edition TNM Lung Cancer Staging System. J Thorac Oncol 2019; 15:649-654. [PMID: 31863848 DOI: 10.1016/j.jtho.2019.11.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We performed a validation study at our institution, the International Union Against Cancer (Union for International Cancer Control latest version of TNM Classification of Malignant Tumors Eighth Edition). METHODS Data were collected from the Queensland Oncology Online registry of NSCLC or SCLC cases between 2000 and 2015 and validated against the Queensland Integrated Lung Cancer Outcomes Project registry using case identification number, first name, last name, and date of birth. Where data were available, cases were classified according to the Union for International Cancer Control TNM seventh edition stage groupings and then compared with the eighth edition groupings. Kaplan-Meier curves were plotted, and the log-rank test of survival differences was performed with SPSS version 25 (IBM Corp, Armonk, NY). RESULTS Of the 3636 cases, 3352 and 1031 had complete clinical and pathologic staging, respectively. Median survival time was found to reduce with increasing clinical stage: seventh edition (IA: 88, IB: 44, IIA: 31, IIB: 18, IIIA: 15, IIIB: 8, and IV: 5 mo) versus eighth edition TNM stage (IA1: not reached, IA2: 88, IA3: 53, IB: 56, IIA: 36, IIB: 22, IIIA: 14, IIIB: 9, IIIC: 8, IVA: 6, and IVB: 3 mo). A similar overall pattern was reflected in the pathologic stage: seventh edition (IA: 124, IB: 110, IIA: 48, IIB: 42, IIIA: 26, IIIB: 31, and IV: 27 mo) versus eighth edition (IA1: not reached, IA2: 122, IA3: 125, IB: 144, IIA: 98, IIB: 57, IIIA: 31, IIIB: 24, and IVA: 7 mo). The log-rank test for survival curves was significant at p < 0.001. CONCLUSIONS Our external validation study confirms the prognostic accuracy of the eighth edition TNM lung cancer classification. Our analyses also indicated that IIIB, IIIC, and IVA stage groups had similar survival outcomes and suggest further research for refinement.
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Affiliation(s)
- Joseph K Hwang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.
| | - Barbara J Page
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - David Flynn
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Linda Passmore
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Elizabeth McCaul
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Jaccalyne Brady
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ian A Yang
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Henry Marshall
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Morgan Windsor
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rayleen V Bowman
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Tracey Guan
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Shoni Philpot
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Michael E Blake
- Cancer Alliance, Queensland, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
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Chen W, Zhang C, Wang G, Yu Z, Liu H. Feasibility of nodal classification for non-small cell lung cancer by merging current N categories with the number of involved lymph node stations. Thorac Cancer 2019; 10:1533-1543. [PMID: 31207184 PMCID: PMC6610263 DOI: 10.1111/1759-7714.13094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction The aim of this study was to assess the prognoses of patients with non‐small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations. Methods Five hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1). Results Five‐year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five‐year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses. Conclusion Pending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.
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Affiliation(s)
- Wei Chen
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Chenlei Zhang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Gebang Wang
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zhanwu Yu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongxu Liu
- Department of Thoracic Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Abstract
In the absence of distant metastases, lung cancer treatment is determined by the results of mediastinal lymph node staging. Occult mediastinal lymph node metastases can be missed by radiologic and needle-based staging methods. Aggressive staging of mediastinal lymph nodes improves staging accuracy. Improved accuracy of mediastinal lymph node staging results in more appropriate lung cancer treatment. Improved accuracy of mediastinal lymph node staging can improve stage-specific survival from lung cancer.
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Affiliation(s)
- Ziv Gamliel
- Thoracic Surgery, Angelos Center for Lung Diseases, MedStar Franklin Square Medical Center, MedStar Harbor Hospital, 9103 Franklin Square Drive, Suite 1800, Baltimore, MD 21237, USA.
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Nakamura T, Otsuki Y, Nakamura H, Funai K. Pleural lavage cytology after lung resection in patients with non-small cell lung cancer and the feasibility of 20 mL saline solution. Asian J Surg 2018; 42:283-289. [PMID: 29628439 DOI: 10.1016/j.asjsur.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND There are two issues to be discussed in pleural lavage cytology (PLC) for resected non-small cell lung cancer (NSCLC) whether it should be performed before (pre-PLC) or after (post-PLC) the lung resection and the dose of saline varies widely among the institutions. METHODS We retrospectively reviewed the clinical records of 466 consecutive patients who underwent a curative resection for NSCLC and received both a pre- and post- PLC using 20 mL of saline from January 2001 to December 2011. RESULTS There were 24/28 of positive pre- and post-PLC and 442/438 negative pre- and post-PLCs, respectively. Patients with a positive pre- or post-PLCs had significantly worse 5-year survival rates than those with negative results (pre-PLC positive/negative; 32.6%/69.9%, p = 0.001, post-PLC positive/negative; 21.4%/71.1%, p < 0.001, respectively). The post-PLC (p = 0.01) was an independent prognostic factor for the overall survival by a multivariate analysis, whereas the pre-PLC was not (p = 0.79). CONCLUSIONS The post-PLC was a more significant prognostic factor than the pre-PLC. Further, 20 mL of saline seemed feasible because of the consistent results compared to the past reports using a greater dose of saline for regarding the positive rates of the PLC and its prognostic significance.
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Affiliation(s)
- Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Hamamatsu, Shizuoka, Japan
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Sakakura N, Mizuno T, Kuroda H, Arimura T, Yatabe Y, Yoshimura K, Sakao Y. The eighth TNM classification system for lung cancer: A consideration based on the degree of pleural invasion and involved neighboring structures. Lung Cancer 2018; 118:134-138. [PMID: 29571992 DOI: 10.1016/j.lungcan.2018.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 02/13/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The eighth tumor-node-metastasis (TNM) classification system for lung cancer has been used since January 2017 and must be applied to an individual institution's database. METHODS We analyzed pathological stage data of 2756 patients who underwent resection of non-small-cell lung cancer, particularly in terms of the degree of visceral pleural invasion and involved neighboring structures. RESULTS Few patients had stage IIA disease (103, 4%); stratification between stages IB and IIA was insufficient (p = 0.129). When T2a tumors were divided into PL1 and PL2 subgroups based on the degree of pleural invasion, there was a significant prognostic difference between the subgroups (p < 0.001). By incorporating T2a tumors with PL2 (T2a-PL2) into the T2b category, modified stages IB, IIA (234, 8%), and IIB were well stratified (IB vs. IIA, p < 0.001; IIA vs. IIB, p = 0.011). Focusing on T3 tumors with PL3 (T3-PL3) invading neighboring structures, multivariate analysis for surveying pT3N0-2M0 tumors revealed that completeness of resection (p = 0.002), implementation of any postoperative therapies (p = 0.003), and subcategorization of whether only the pleura was infiltrated or other deeper structures were also invaded (p = 0.024) were significant and crucial predictors. N2 disease showed worse outcome than N0-1 diseases, with marginal difference (p = 0.054). CONCLUSION T2a-PL2 tumors could be categorized into a worse prognostic T2b category. For T3-PL3 tumors involving resectable neighboring organs, subcategorization of whether there is only pleura infiltration (T3a) or other deeper structure invasion (T3b) could be a practical consideration.
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Affiliation(s)
- Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Tetsuya Mizuno
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Arimura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, Rusch VW, Kernstine K. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018; 13:801-809. [PMID: 29476906 DOI: 10.1016/j.jtho.2018.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/14/2018] [Accepted: 02/14/2018] [Indexed: 12/22/2022]
Abstract
Over the past two decades, the International Association for the Study of Lung Cancer (IASLC) Staging Project has been a steady source of evidence-based recommendations for the TNM classification for lung cancer published by the Union for International Cancer Control and the American Joint Committee on Cancer. The Staging and Prognostic Factors Committee of the IASLC is now issuing a call for participation in the next phase of the project, which is designed to inform the ninth edition of the TNM classification for lung cancer. Following the case recruitment model for the eighth edition database, volunteer site participants are asked to submit data on patients whose lung cancer was diagnosed between January 1, 2011, and December 31, 2019, to the project by means of a secure, electronic data capture system provided by Cancer Research And Biostatistics in Seattle, Washington. Alternatively, participants may transfer existing data sets. The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.
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Affiliation(s)
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Network of Centers of Biomedical Research in Respiratory Diseases (CIBERES), Lung Cancer Group, Terrassa, Spain
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kemp Kernstine
- Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas
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Millon D, Byl D, Collard P, Cambier SE, Van Maanen AG, Vlassenbroek A, Coche EE. Could new reconstruction CT techniques challenge MRI for the detection of brain metastases in the context of initial lung cancer staging? Eur Radiol 2018; 28:770-9. [PMID: 28856413 DOI: 10.1007/s00330-017-5021-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of brain CT images reconstructed with a model-based iterative algorithm performed at usual and reduced dose. METHODS 115 patients with histologically proven lung cancer were prospectively included over 15 months. Patients underwent two CT acquisitions at the initial staging, performed on a 256-slice MDCT, at standard (CTDIvol: 41.4 mGy) and half dose (CTDIvol: 20.7 mGy). Both image datasets were reconstructed with filtered back projection (FBP) and iterative model-based reconstruction (IMR) algorithms. Brain MRI was considered as the reference. Two blinded independent readers analysed the images. RESULTS Ninety-three patients underwent all examinations. At the standard dose, eight patients presented 17 and 15 lesions on IMR and FBP CT images, respectively. At half-dose, seven patients presented 15 and 13 lesions on IMR and FBP CT images, respectively. The test could not highlight any significant difference between the standard dose IMR and the half-dose FBP techniques (p-value = 0.12). MRI showed 46 metastases on 11 patients. Specificity, negative and positive predictive values were calculated (98.9-100 %, 93.6-94.6 %, 75-100 %, respectively, for all CT techniques). CONCLUSION No significant difference could be demonstrated between the two CT reconstruction techniques. KEY POINTS • No significant difference between IMR100 and FBP50 was shown. • Compared to FBP, IMR increased the image quality without diagnostic impairment. • A 50 % dose reduction combined with IMR reconstructions could be achieved. • Brain MRI remains the best tool in lung cancer staging.
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28
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Abstract
Combined endosonographic lymph node biopsy techniques are a minimally invasive alternative to surgical staging in non-small cell lung cancer and may be superior to standard mediastinoscopy and surgical mediastinal staging techniques. Endosonography allows for the biopsy of lymph nodes and metastases unattainable with standard mediastinoscopy. Standard cervical mediastinoscopy is an invasive procedure, which requires general anesthesia and is associated with higher risk, cost, and major complication rates compared with minimally invasive endosonographic biopsy techniques. Combined endosonographic procedures are the new gold standard in staging of non-small cell lung cancer when performed by an experienced operator.
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Affiliation(s)
- Pravachan V C Hegde
- Fresno Medical Education Program, Advanced Interventional Thoracic Endoscopy/Interventional Pulmonology, Division of Pulmonary & Critical Care Medicine, University of California San Francisco (UCSF), 2335 East Kashian Lane, Suite 260, Fresno, CA 93701, USA.
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street East, 8e CD, Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
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Teoh EJ, McGowan DR, Bradley KM, Belcher E, Black E, Moore A, Sykes A, Gleeson FV. 18F-FDG PET/CT assessment of histopathologically confirmed mediastinal lymph nodes in non-small cell lung cancer using a penalised likelihood reconstruction. Eur Radiol 2016; 26:4098-4106. [PMID: 26914696 PMCID: PMC4898597 DOI: 10.1007/s00330-016-4253-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/23/2015] [Accepted: 01/26/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate whether using a Bayesian penalised likelihood reconstruction (BPL) improves signal-to-background (SBR), signal-to-noise (SNR) and SUVmax when evaluating mediastinal nodal disease in non-small cell lung cancer (NSCLC) compared to ordered subset expectation maximum (OSEM) reconstruction. MATERIALS AND METHODS 18F-FDG PET/CT scans for NSCLC staging in 47 patients (112 nodal stations with histopathological confirmation) were reconstructed using BPL and compared to OSEM. Node and multiple background SUV parameters were analysed semi-quantitatively and visually. RESULTS Comparing BPL to OSEM, there were significant increases in SUVmax (mean 3.2-4.0, p<0.0001), SBR (mean 2.2-2.6, p<0.0001) and SNR (mean 27.7-40.9, p<0.0001). Mean background SNR on OSEM was 10.4 (range 7.6-14.0), increasing to 12.4 (range 8.2-16.7, p<0.0001). Changes in background SUVs were minimal (largest mean difference 0.17 for liver SUVmean, p<0.001). There was no significant difference between either algorithm on receiver operating characteristic analysis (p=0.26), although on visual analysis, there was an increase in sensitivity and small decrease in specificity and accuracy on BPL. CONCLUSION BPL increases SBR, SNR and SUVmax of mediastinal nodes in NSCLC compared to OSEM, but did not improve the accuracy for determining nodal involvement. KEY POINTS • Penalised likelihood PET reconstruction was applied for assessing mediastinal nodes in NSCLC. • The new reconstruction generated significant increases in signal-to-background, signal-to-noise and SUVmax. • This led to an improvement in visual sensitivity using the new algorithm. • Higher SUV max thresholds may be appropriate for semi-quantitative analyses with penalised likelihood.
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Affiliation(s)
- Eugene J Teoh
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
- Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK.
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK.
| | - Kevin M Bradley
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Edward Black
- Department of Thoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Alastair Moore
- Department of Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Annemarie Sykes
- Department of Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
| | - Fergus V Gleeson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, UK
- Department of Oncology, University of Oxford, Oxford, OX3 7DQ, UK
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30
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Detterbeck FC, Chansky K, Groome P, Bolejack V, Crowley J, Shemanski L, Kennedy C, Krasnik M, Peake M, Rami-Porta R. The IASLC Lung Cancer Staging Project: Methodology and Validation Used in the Development of Proposals for Revision of the Stage Classification of NSCLC in the Forthcoming (Eighth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1433-46. [PMID: 27448762 DOI: 10.1016/j.jtho.2016.06.028] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage classification provides a consistent language to describe the anatomic extent of disease and is therefore a critical tool in caring for patients. The Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer developed proposals for revision of the classification of lung cancer for the eighth edition of the tumor, node, and metastasis (TNM) classification, which takes effect in 2017. METHODS An international database of 94,708 patients with lung cancer diagnosed in 1999-2010 was assembled. This article describes the process and statistical methods used to refine the lung cancer stage classification. RESULTS Extensive analysis allowed definition of tumor, node, and metastasis categories and stage groupings that demonstrated consistent discrimination overall and within multiple different patient cohorts (e.g., clinical or pathologic stage, R0 or R-any resection status, geographic region). Additional analyses provided evidence of applicability over time, across a spectrum of geographic regions, histologic types, evaluative approaches, and follow-up intervals. CONCLUSIONS An extensive analysis has produced stage classification proposals for lung cancer with a robust degree of discriminatory consistency and general applicability. Nevertheless, external validation is encouraged to identify areas of strength and weakness; a sound validation should have discriminatory ability and be based on an independent data set of adequate size and sufficient follow-up with enough patients for each subgroup.
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Affiliation(s)
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | - Patti Groome
- Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | | | - John Crowley
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Catherine Kennedy
- University of Sydney, Strathfield Private Hospital Campus, Strathfield, New South Wales, Australia
| | - Mark Krasnik
- Gentofte University Hospital, Copenhagen, Denmark
| | | | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa and Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, Goo JM, MacMahon H, Naidich D, Nicholson AG, Powell CA, Prokop M, Rami-Porta R, Rusch V, van Schil P, Yatabe Y. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1204-1223. [PMID: 27107787 DOI: 10.1016/j.jtho.2016.03.025] [Citation(s) in RCA: 460] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/15/2022]
Abstract
This article proposes codes for the primary tumor categories of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) and a uniform way to measure tumor size in part-solid tumors for the eighth edition of the tumor, node, and metastasis classification of lung cancer. In 2011, new entities of AIS, MIA, and lepidic predominant adenocarcinoma were defined, and they were later incorporated into the 2015 World Health Organization classification of lung cancer. To fit these entities into the T component of the staging system, the Tis category is proposed for AIS, with Tis (AIS) specified if it is to be distinguished from squamous cell carcinoma in situ (SCIS), which is to be designated Tis (SCIS). We also propose that MIA be classified as T1mi. Furthermore, the use of the invasive size for T descriptor size follows a recommendation made in three editions of the Union for International Cancer Control tumor, node, and metastasis supplement since 2003. For tumor size, the greatest dimension should be reported both clinically and pathologically. In nonmucinous lung adenocarcinomas, the computed tomography (CT) findings of ground glass versus solid opacities tend to correspond respectively to lepidic versus invasive patterns seen pathologically. However, this correlation is not absolute; so when CT features suggest nonmucinous AIS, MIA, and lepidic predominant adenocarcinoma, the suspected diagnosis and clinical staging should be regarded as a preliminary assessment that is subject to revision after pathologic evaluation of resected specimens. The ability to predict invasive versus noninvasive size on the basis of solid versus ground glass components is not applicable to mucinous AIS, MIA, or invasive mucinous adenocarcinomas because they generally show solid nodules or consolidation on CT.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Beasley
- Department of Pathology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Frank Detterbeck
- Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heber MacMahon
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - David Naidich
- Department of Radiology, New York University Langone Medical Center, New York University, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - Charles A Powell
- Pulmonary Critical Care and Sleep Medicine, Ichan School of Medicine, New York, New York
| | - Mathias Prokop
- Department of Radiology, Radboud University Nymegen Medical Center, Nymegen, The Netherlands
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
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Calvo Temprano D, Esteban E, Jiménez Fonseca P, Fernández-Mariño B. CT scan prior to radiotherapy in unresectable, locally advanced, non-small cell carcinoma of the lung: is it always necessary? Clin Transl Oncol 2016; 19:105-110. [PMID: 27091132 DOI: 10.1007/s12094-016-1510-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/05/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE There is broad consensus regarding evaluating response to chemotherapy (CHT) by means of computerized tomography (CT) in patients with localized or locally advanced non-small cell lung carcinoma (NSCLC). We present a study comparing the usefulness of CT versus chest X-ray (XR) and clinical findings when indicating radiotherapy (RT) following CHT. METHODS Ninety-eight of 150 subjects with unresectable locally advanced NSCLC were blindly and independently evaluated by XR and CT, with pairs of chest XR and CT (before and after CHT). A null hypothesis (H0) was established of the conditioned probability of detecting progression by CT and not by XR of 10 % or more, with a statistical power of 80 %. RESULTS Sensitivity, specificity, positive and negative predictive value of XR versus CT were 98, 89, 99, and 80 % respectively. A 4 % (p = 0.0451) probability of improvement of CT versus XR was calculated, enabling the H0 to be ruled out. CONCLUSION The CT failed to prove to be significantly superior to the chest XR + clinical picture in indicating a change in treatment approach in patients with unresectable locally advanced NSCLC after CHT.
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MESH Headings
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adult
- Aged
- Carcinoma, Large Cell/diagnostic imaging
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Radiography, Thoracic/methods
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- D Calvo Temprano
- Radiology Service, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, ES-33011, Oviedo, Asturias, Spain.
| | - E Esteban
- Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - P Jiménez Fonseca
- Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - B Fernández-Mariño
- Radiology Service, Hospital Universitario Central de Asturias, Avenida de Roma, s/n, ES-33011, Oviedo, Asturias, Spain
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Detterbeck FC, Marom EM, Arenberg DA, Franklin WA, Nicholson AG, Travis WD, Girard N, Mazzone PJ, Donington JS, Tanoue LT, Rusch VW, Asamura H, Rami-Porta R. The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification. J Thorac Oncol 2016; 11:666-680. [PMID: 26940527 DOI: 10.1016/j.jtho.2015.12.113] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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Affiliation(s)
| | - Edith M Marom
- Department of Diagnostic Imaging, Tel-Aviv University, Ramat Gan, Israel
| | - Douglas A Arenberg
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - William D Travis
- Department of Pathology, Sloan-Kettering Cancer Center, New York, New York
| | - Nicolas Girard
- Respiratory Medicine Service, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Peter J Mazzone
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Lynn T Tanoue
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Valerie W Rusch
- Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
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Dziedzic DA, Rudzinski P, Langfort R, Orlowski T; Polish Lung Cancer Study Group (PLCSG). Risk Factors for Local and Distant Recurrence After Surgical Treatment in Patients With Non-Small-Cell Lung Cancer. Clin Lung Cancer 2016; 17:e157-67. [PMID: 26831834 DOI: 10.1016/j.cllc.2015.12.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/25/2015] [Accepted: 12/30/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The purpose of this study was to identify independent perioperative and pathologic variables associated with non-small-cell lung cancer (NSCLC) recurrence after complete surgical resection. PATIENTS AND METHODS A retrospective examination was performed of a prospectively maintained database of patients who underwent resection for NSCLC from January 2009 to January 2014 at a multi-institution. Clinicopathologic variables were evaluated for their influence on frequency of recurrence. Cox proportional regression hazard model analysis examined the association of recurrence in NSCLC. RESULTS Of these patients, 2816 (19.3%) experienced recurrence of primary cancer. Local or distant recurrence was found in 20.5% and 79.5% of patients, respectively. Median follow-up was 27.9 months (range, 11.4-66.0 months). The analysis indicated independent effects of the following risk factors on the risk of recurrence: age 64-90 years (hazard ratio [HR], 1.136; 95% confidence interval [CI] 1.024-1.261), histologic type adenocarcinoma (HR, 1.117; 95% CI 1.005-1.24), blood vessel invasion (HR, 1.236; 95% CI, 1.124-1.359), lymphatic vessel invasion (HR, 1.287; 95% CI, 1.176-1.409), visceral pleural invasion (HR, 1.641; 95% CI, 1.215-2.218), N1 disease (HR, 1.142; 95% CI, 0.99-1.316), N2 disease (HR, 1.596; 95% CI, 1.271-1.649), tumor size of 20-30 mm (HR, 1.235; 95% CI, 1.081-1.41), 30-50 mm (HR, 1.544; 95% CI, 1.33-1.792), 50-70 mm (HR, 1.521; 95% CI, 1.275-1.815), and 70-100 mm (HR, 1.71; 95% CI, 1.385-2.11), pneumonectomy (HR, 1.08; 95% CI, 0.97-1.203), and sublobar resection (HR, 1.762; 95% CI, 1.537-2.019). CONCLUSION In the largest series reported to date on postresection recurrence of NSCLC, increasing pathologic stage, advanced age, pneumonectomy, sublobar resection, lymphatic and blood vessel invasion, and visceral pleural invasion were independently associated with local and distant recurrence.
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Nicholson AG, Chansky K, Crowley J, Beyruti R, Kubota K, Turrisi A, Eberhardt WEE, van Meerbeeck J, Rami-Porta R, Asamura H, Ball D, Beer DG, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck F, Erich Eberhardt WE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut T, Lyons G, Marino M, Marom EM, van Meerbeeck J, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice T, Rosenzweig K, Ruffini E, Rusch V, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF, Travis W, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Cavaco FA, Barrera EA, Arca JA, Lamelas IP, Obrer AA, Jorge RG, Ball D, Bascom G, Blanco Orozco A, González Castro M, Blum M, Chimondeguy D, Cvijanovic V, Defranchi S, de Olaiz Navarro B, Escobar Campuzano I, Vidueira IM, Araujo EF, García FA, Fong K, Corral GF, González SC, Gilart JF, Arangüena LG, Barajas SG, Girard P, Goksel T, González Budiño M, González Casaurrán G, Gullón Blanco J, Hernández Hernández J, Rodríguez HH, Collantes JH, Heras MI, Izquierdo Elena J, Jakobsen E, Kostas S, Atance PL, Ares AN, Liao M, Losanovscky M, Lyons G, Magaroles R, De Esteban Júlvez L, Gorospe MM, McCaughan B, Kennedy C, Melchor Íñiguez R, Miravet Sorribes L, Naranjo Gozalo S, de Arriba CÁ, Núñez Delgado M, Alarcón JP, Peñalver Cuesta J, Park J, Pass H, Pavón Fernández M, Rosenberg M, Rusch V, de Cos Escuín JS, Vinuesa AS, Serra Mitjans M, Strand T, Subotic D, Swisher S, Terra R, Thomas C, Tournoy K, Van Schil P, Velasquez M, Wu Y, Yokoi K. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the Clinical and Pathologic Staging of Small Cell Lung Cancer in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 11:300-11. [PMID: 26723244 DOI: 10.1016/j.jtho.2015.10.008] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Small cell lung cancer (SCLC) is commonly classified as either limited or extensive, but the Union for International Cancer Control TNM Classification of Malignant Tumours seventh edition (2009) recommended tumor, node, and metastasis (TNM) staging based on analysis of the International Association for the Study of Lung Cancer (IASLC) database. METHODS Survival analyses were performed for clinically and pathologically staged patients presenting with SCLC from 1999 through 2010. Prognosis was compared in relation to the TNM seventh edition staging to serve as validation and analyzed in relation to proposed changes to the T descriptors found in the eighth edition. RESULTS There were 5002 patients: 4848 patients with clinical and 582 with pathological stages. Among these, 428 had both. Survival differences were confirmed for T and N categories and maintained in relation to proposed revisions to T descriptors for seventh edition TNM categories and proposed changes in the eighth edition. There were also survival differences, notably at 12 months, in patients with brain-only single-site metastasis (SSM) compared to SSM at other sites, and SSM without a pleural effusion showed a better prognosis than other patients in the M1b category. CONCLUSION We confirm the prognostic value of clinical and pathological TNM staging in patients with SCLC, and recommend continued usage for SCLC in relation to proposed changes to T, N, and M descriptors for NSCLC in the eighth edition. However, for M descriptors, it remains uncertain whether survival differences in patients with SSM in the brain simply reflect better treatment options rather than better survival based on anatomic extent of disease.
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Affiliation(s)
- Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.
| | - Kari Chansky
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - John Crowley
- Cancer Research and Biostatistics, Seattle, WA, USA
| | - Ricardo Beyruti
- Department of Thoracic Surgery, University of São Paulo, São Paulo, Brazil
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Andrew Turrisi
- Department of Radiotherapy, Sinai Grace Hospital, Detroit, MI, USA
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Germany
| | - Jan van Meerbeeck
- Department of Oncology, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
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Shafiek H, Fiorentino F, Peralta AD, Serra E, Esteban B, Martinez R, Noguera MA, Moyano P, Sala E, Sauleda J, Cosío BG. Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound. Arch Bronconeumol 2014; 50:228-34. [PMID: 24512940 DOI: 10.1016/j.arbres.2013.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 11/20/2013] [Accepted: 12/16/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. METHODS 208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. CONCLUSIONS Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.
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Mirsadraee S, Oswal D, Alizadeh Y, Caulo A, Beek EJRV. The 7th lung cancer TNM classification and staging system: Review of the changes and implications. World J Radiol 2012; 4:128-34. [PMID: 22590666 PMCID: PMC3351680 DOI: 10.4329/wjr.v4.i4.128] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 04/20/2012] [Accepted: 04/27/2012] [Indexed: 02/06/2023] Open
Abstract
Lung cancer is the most common cause of death from cancer in males, accounting for more than 1.4 million deaths in 2008. It is a growing concern in China, Asia and Africa as well. Accurate staging of the disease is an important part of the management as it provides estimation of patient’s prognosis and identifies treatment sterategies. It also helps to build a database for future staging projects. A major revision of lung cancer staging has been announced with effect from January 2010. The new classification is based on a larger surgical and non-surgical cohort of patients, and thus more accurate in terms of outcome prediction compared to the previous classification. There are several original papers regarding this new classification which give comprehensive description of the methodology, the changes in the staging and the statistical analysis. This overview is a simplified description of the changes in the new classification and their potential impact on patients’ treatment and prognosis.
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