Jee Won Suh1, Yong Hyu Jeong2, Arthur Cho2, Dae Joon Kim3, Kyoung Young Chung3, Hyo Sup Shim4, Chang Young Lee5. 1. Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Republic of Korea. 2. Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. 3. Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. 4. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. Electronic address: SHIMHS@yuhs.ac. 5. Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Republic of Korea. Electronic address: CYLEECS@yuhs.ac.
Abstract
OBJECTIVES: The sensitivity for tumor spread through air space (STAS), an independent risk factor for locoregional recurrence after sublobar resection for lung cancer, has been relatively low in frozen sections. We aimed to determine predictors with high negative predictive value for the presence of STAS and to provide the flowchart in combination with these predictors for the decision-making for sublobar resection. MATERIALS AND METHODS: Between July 2015 and December 2017, 387 patients who underwent surgery for non-small cell lung cancer (NSCLC) with pathologic findings of the total masses measuring ≤ 2 cm were enrolled. The lesions were divided into two groups according to presence of STAS. We compared the preoperative characteristics, operative data, and developed a flowchart for STAS prediction using receiver operator characteristic curve analysis and multivariable logistic regression. RESULTS: The STAS-positive group (N = 111) had a significantly higher preoperative tumor size (1.70 [1.5] vs 1.50 [0.69], p < 0.001) and standardized uptake value tumor-to-liver (SUV T/L) ratio (1.40 [1.60] vs 0.60 [1.10], p < 0.001) and a significantly lower two-dimensional ground-glass opacity (GGO) percentage (35.86 [61.00] vs 78.14 [39.00], p < 0.001). Meanwhile, the STAS-negative group (N = 286) had higher lepidic predominance (41.6% vs. 1.8%, p < 0.001). We developed a flowchart for predicting STAS in combination with two-dimensional GGO percentage on computed tomography (CT), SUV T/L ratio on positron-emission CT, and lepidic predominant pattern. The sensitivity, specificity, and negative predictive value for STAS positivity were 79.3%, 68.5%, and 89.5%, respectively. CONCLUSIONS: The stepwise flowchart using two-dimensional GGO percentage on CT, maximum SUV, and lepidic predominance might be helpful in selecting patients with early NSCLC for sublobar resection. Published by Elsevier B.V.
OBJECTIVES: The sensitivity for tumor spread through air space (STAS), an independent risk factor for locoregional recurrence after sublobar resection for lung cancer, has been relatively low in frozen sections. We aimed to determine predictors with high negative predictive value for the presence of STAS and to provide the flowchart in combination with these predictors for the decision-making for sublobar resection. MATERIALS AND METHODS: Between July 2015 and December 2017, 387 patients who underwent surgery for non-small cell lung cancer (NSCLC) with pathologic findings of the total masses measuring ≤ 2 cm were enrolled. The lesions were divided into two groups according to presence of STAS. We compared the preoperative characteristics, operative data, and developed a flowchart for STAS prediction using receiver operator characteristic curve analysis and multivariable logistic regression. RESULTS: The STAS-positive group (N = 111) had a significantly higher preoperative tumor size (1.70 [1.5] vs 1.50 [0.69], p < 0.001) and standardized uptake value tumor-to-liver (SUV T/L) ratio (1.40 [1.60] vs 0.60 [1.10], p < 0.001) and a significantly lower two-dimensional ground-glass opacity (GGO) percentage (35.86 [61.00] vs 78.14 [39.00], p < 0.001). Meanwhile, the STAS-negative group (N = 286) had higher lepidic predominance (41.6% vs. 1.8%, p < 0.001). We developed a flowchart for predicting STAS in combination with two-dimensional GGO percentage on computed tomography (CT), SUV T/L ratio on positron-emission CT, and lepidic predominant pattern. The sensitivity, specificity, and negative predictive value for STAS positivity were 79.3%, 68.5%, and 89.5%, respectively. CONCLUSIONS: The stepwise flowchart using two-dimensional GGO percentage on CT, maximum SUV, and lepidic predominance might be helpful in selecting patients with early NSCLC for sublobar resection. Published by Elsevier B.V.
Entities:
Keywords:
Ground glass opacity; Lung cancer; Sublobar resection; Tumor spread through air space
Authors: Massimiliano Bassi; Andrea Russomando; Jacopo Vannucci; Andrea Ciardiello; Miriam Dolciami; Paolo Ricci; Angelina Pernazza; Giulia D'Amati; Carlo Mancini Terracciano; Riccardo Faccini; Sara Mantovani; Federico Venuta; Cecilia Voena; Marco Anile Journal: Transl Lung Cancer Res Date: 2022-04