Yong Wang1, Yeqing Zhu2, Rowena Yip3, Dong-Seok Lee4, Raja M Flores5, Andrew Kaufman5, Claudia I Henschke6, David F Yankelevitz7. 1. Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China. 2. 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. 3. Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA. 4. Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA. 5. 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. 6. 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. Electronic address: Claudia.henschke@mountsinai.org. 7. Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA.
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.
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.
Authors: Claudia I Henschke; Rowena Yip; Dorith Shaham; Javier J Zulueta; Samuel M Aguayo; Anthony P Reeves; Artit Jirapatnakul; Ricardo Avila; Drew Moghanaki; David F Yankelevitz Journal: J Thorac Imaging Date: 2021-01 Impact factor: 5.528