| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2003;23:403-408
© 2003 Elsevier Science NL
a Department of Cardiothoracic surgery, Tampere University Hospital, Tampere, Finland
b Department of Radiology, Tampere University Hospital, Tampere, Finland
c Department of Pathology, Tampere University Hospital, Tampere, Finland
d Department of Pulmonary Medicine, Tampere University Hospital, Tampere, Finland
Received 6 May 2002; received in revised form 26 November 2002; accepted 2 December 2002.
* Corresponding author. Kaustakuja 6A, 00950 Helsinki, Finland
e-mail: sioris{at}saunalahti.fi
Objective: To compare computed tomography (CT)-based clinical TNM and staging to surgical-pathological staging with systematic lymph node dissection in primary non-small cell lung cancer. Methods: The study included 49 non-small cell lung cancer patients that underwent lung resection and systematic lymph node dissection between 1997 and 2001. Preoperative clinical and CT findings were compared with surgical-pathological findings. Lymph nodes with a shortest diameter of over 1 cm on CT were considered abnormal, but did not contraindicate surgery. Patients with CT indicating an invasive T4 tumor, pleural carcinosis, or bulky N2 disease were excluded. Results: Sixty-five percent (32/49) had epidermoid carcinoma, and 25% (12/49) had adenocarcinoma. N2 metastases were found in 12% (6/49). The clinical T category was correct in 71% (35/49), and the N category in 55% (27/49). The sensitivity for detecting N2 disease was 67% (4/6), and the spesificity was 81% (35/43). The positive predictive value for N2 disease was 33% (4/12), and the negative predictive value was 95% (35/37). Node-by-node agreement on N2 metastatic location was 17% (1/6). Skip N2 metastases without any N1 involvement were found in 4% (2/49), or 33% (2/6) of all N2 cases. The clinical stage was correct in 45% (22/49), and complete TNM agreement was 37% (18/49). Conclusions: The clinical TNM and staging based on CT are inaccurate. The sensitivity for detecting N2 disease is poor, especially on node-by node basis. Preoperative exclusion of N2 metastases is quite reliable, but a positive finding should always be verified. Systematic mediastinal lymph node dissection is necessary to detect N2 metastases inaccessible to cervical mediastinoscopy, and skip N2 metastases without N1 involvement.
Key Words: Non-small cell lung cancer • Computed tomography • Staging • Operability • Systematic lymph node dissection • Skip metastasis
This article has been cited by other articles:
|
|
 |
|
  C. Vergani, F. Varoli, L. Despini, S. Harari, E. Mozzi, and G. Roviaro Routine surgical videothoracoscopy as the first step of the planned resection for lung cancer J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1206 - 1212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. B. Ratto, R. Costa, P. Maineri, A. Alloisio, P. Bruzzi, and B. Dozin Is there a subset of patients with preoperatively diagnosed N2 non-small cell lung cancer who might benefit from surgical resection? J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 849 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tamura, M. Oda, Y. Tsunezuka, I. Matsumoto, K. Kawakami, Y. Ohta, and G. Watanabe Chest CT and Serum Vascular Endothelial Growth Factor-C Level To Diagnose Lymph Node Metastasis in Patients With Primary Non-small Cell Lung Cancer Chest, August 1, 2004; 126(2): 342 - 346. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
