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European Journal of Cardio-Thoracic Surgery, Vol 12, 224-227, Copyright © 1997 by European Association for Cardio-thoracic Surgery
A Gdeedo, P Van Schil, B Corthouts, F Van Mieghem, J Van Meerbeeck and E Van Marck
OBJECTIVE: Precise tumor (T) and nodal (N) staging is imperative in non-
small cell lung cancer (NSCLC) as it determines subsequent treatment,
certainly when considering neoadjuvant treatment for stage IIIA or IIIB
disease. To determine the accuracy of present-day computed tomographic (CT)
scanning a prospective study was performed comparing imaging TNM [(i)TNM]
and pathological TNM [pTNM]. METHODS: In 74 patients with NSCLC without
distant metastases (i)TNM was determined on CT findings. The TNM system
advocated by the American Joint Committee on Cancer was used. All patients
underwent cervical mediastinoscopy. When superior mediastinal nodes were
negative this was followed by thoracotomy and pathological examination of
the resected specimen and lymph nodes to determine pTNM. RESULTS: The
agreement between (i)TNM and pTNM was only 35.1%. The primary tumor (T) was
correctly staged in 54.1%, overstaged in 27.0% and understaged in 18.9% of
the patients. Invasion of chest wall, pericardium and of major mediastinal
structures (T3, T4) was not reliably detected by CT scan. Sensitivity and
specificity of CT regarding hilar and mediastinal lymph node staging were
48.3 and 53.3%, positive and negative predictive value 40 and 61.1% and its
overall accuracy 51.4%. The nodal (N) factor was correctly determined by CT
scan in 35.1%, overstaged in 44.6%, and understaged in 20.3% of the
patients. CONCLUSIONS: Even with present-day CT scanners (i)TNM provides no
accurate staging and routine mediastinoscopy is necessary for precise
mediastinal lymph node staging. Likewise, (i)T3 and (i)T4 determinations
are unreliable and should not contraindicate thoracotomy.
ARTICLES
Comparison of imaging TNM [(i)TNM] and pathological TNM [pTNM] in staging of bronchogenic carcinoma
Department of Surgery, University Hospital of Antwerp, Edegem, Belgium.
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