Centrally located lung cancer and risk of occult nodal disease: an objective evaluation of multiple definitions of tumour centrality with dedicated imaging software

The European Respiratory Journal
Roberto F CasalDavid E Ost

Abstract

Current guidelines recommend invasive mediastinal staging in patients with centrally located radiographic stage T1N0M0 nonsmall cell lung cancer (NSCLC). The lack of a specific definition of a central tumour has resulted in discrepancies among guidelines and heterogeneity in practice patterns. Our objective was to study specific definitions of tumour centrality and their association with occult nodal disease. Pre-operative chest computed tomography scans from patients with clinical (c) T1N0M0 NSCLC were processed with a dedicated software system that divides the lungs in thirds following vertical and concentric lines. This software accurately assigns tumours to a specific third based both on the location of the centre of the tumour and its most medial aspect, creating eight possible definitions of central tumours. 607 patients were included in our study. Surgery was performed for 596 tumours (98%). The overall pathological (p) N disease was: 504 (83%) N0, 56 (9%) N1, 47 (8%) N2 and no N3. The prevalence of N2 disease remained relatively low regardless of tumour location. Central tumours were associated with upstaging from cN0 to any N (pN1/pN2). Two definitions were associated with upstaging to any N: concentric lines, inner on...Continue Reading

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Citations

Oct 2, 2019·American Journal of Respiratory and Critical Care Medicine·Gabriela Martinez-ZayasDavid E Ost
Dec 12, 2019·Annals of the American Thoracic Society·Pascalin RoyMarc Fortin
Jul 14, 2020·Respirology : Official Journal of the Asian Pacific Society of Respirology·José Sanz-Santos, Sergi Call
Aug 28, 2020·The Annals of Thoracic Surgery·José Sanz-SantosJosep Belda
Aug 24, 2020·Archivos de bronconeumología·Mireia Martínez-PalauJosé Sanz-Santos
Sep 20, 2021·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Merve KucukerBehice Durgun

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