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Zhu Y, Cai Q, Wang Y, You N, Yip R, Lee DS, Taioli E, Flores R, Henschke CI, Yankelevitz DF. Pre-surgical assessment of mediastinal lymph node metastases in patients having ≥ 30 mm non-small-cell lung cancers. Lung Cancer 2021; 161:189-196. [PMID: 34624614 DOI: 10.1016/j.lungcan.2021.09.013] [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: 04/19/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Computed tomography (CT) and fluorodeoxyglucose-positron-emission-tomography (FDG-PET) measurements of mediastinal lymph nodes (MLNs) of patients with non-small-cell-lung-cancers (NSCLCs) ≤ 30 mm in maximum diameter are recommended for pre-surgical prediction of MLN metastases. METHODS We reviewed all patients at Mount Sinai Health System enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART), prospective cohort between 2016 and 2020, who had pre-surgical FDG-PET and underwent surgery with MLN resection and/or pre-operative endobronchial ultrasound (EBUS) for a first primary NSCLC ≤ 30 mm in maximum diameter on pre-surgical CT. RESULTS Among 470 patients, none with part-solid (n = 63) or nonsolid (n = 23) NSCLCs had MLN metastases. Solid NSCLCs were identified in 384 patients, none in typical carcinoid (n = 48) or NSCLC ≤ 10 mm in maximum diameter (n = 47, including 8 typical carcinoids) had MLN metastases. Among the remaining 297 patients with solid NSCLCs 10.1-30.0 mm, 7 (2.4%) had MLN metastases. Area-under-the-curve (AUC) for predicting MLN metastases in solid NSCLCs 10.1-30.0 mm, using the CT maximum short-axis MLN diameter was 0.62 (95% CI:0.44-0.81, p = 0.18) and using the highest SUVmax of any MLN, AUC was 0.58 (95% CI:0.39-0.78,p = 0.41). Neither AUCs were significantly different from chance alone. Optimal cutoff for prediction of MLN metastases was ≥ 18.9 mm for CT maximum short-axis diameter [sensitivity 14.3% (95%CI:0.0%-57.9%); specificity 100.0% (95%CI:98.9%-100.0%)] and for highest SUVmax was ≥ 11.7 [sensitivity 14.3% (95%CI:0.0%-57.9%) and specificity 99.7% (95%CI:98.3%-100.0%)]. CONCLUSIONS CT and SUVmax had low sensitivity but high specificity for predicting MLN metastases in solid NSCLCs 10.1-30.0 mm. Clinical Stage IA NSCLCs ≤ 30 mm should be based on CT maximum tumor diameter and MLN maximum short-axis diameter ≤ 20 mm.
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Affiliation(s)
- Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qiang Cai
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012 China
| | - Yong Wang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Nan You
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Wang Y, Zhu Y, Yip R, Lee DS, Flores RM, Kaufman A, Henschke CI, Yankelevitz DF. Pre-surgical assessment of mediastinal lymph node metastases in Stage IA non-small-cell lung cancers. Clin Imaging 2020; 68:61-67. [PMID: 32570011 DOI: 10.1016/j.clinimag.2020.06.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Evaluation of sensitivity and specificity of CT and fluorodeoxyglucose-positron emission tomography for pre-surgical staging of mediastinal lymph node metastases (N2/N3) of non-small-cell-lung-cancers ≤30 mm. METHODS We reviewed a total of 263 patients from a prospective cohort study, who underwent resection including mediastinal lymph nodes, for first primary non-small-cell-lung-cancer ≤30 mm in maximum diameter on pre-surgical CT. Cutoff criteria for short-axis diameter on CT of the largest N2/N3 node of 10, 15, and 20 mm and positron emission uptake of 2.5, 3.0, and 4.0 were evaluated using Area-Under-the-Curve (AUC) assessment. Accuracy criterion was used to determine the optimal cutoffs. RESULTS Of 263 patients, 9 had nonsolid, 42 part-solid, and 212 solid non-small-cell-lung-cancers. Post-surgically, none of the 51 patients with nonsolid or part-solid cancers had mediastinal lymph node metastases. Among the 212 patients with solid cancers, 23 had N2 node metastases. For the 212 patients with solid cancers, the AUC for CT lymph node measurements was 0.67 (95% CI: 0.57-0.77), significantly higher (p = 0.001) than chance alone, while the AUC for SUVmax measurements, 0.56 (95% CI: 0.48-0.65), was not (p = 0.13). Optimal CT cutoff was >20 mm had low sensitivity of 30.4% (95% CI: 11.6%-49.2%) but high specificity of 99.5% (95% CI: 98.4%-100.0%). CONCLUSION Based on these results, clinical Stage IA for non-small-cell-lung-cancers with nonsolid, part-solid, or solid consistency should be based on pre-surgical CT maximum tumor diameter and lymph node short-axis measurements on CT ≤20 mm. Further prospective evaluation of these clinical Stage IA staging criteria is needed.
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Affiliation(s)
- Yong Wang
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yeqing Zhu
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rowena Yip
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA; Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA.
| | - David F Yankelevitz
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
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