Hang Li1,2,3, Ting Ye1,2,3, Nan Li3,4, Guozhan Xia1,2,3, Bin Li1,2,3, Yang Zhang1,2,3, Hong Hu1,2,3, Yihua Sun1,2,3, Yawei Zhang1,2,3, Jiaqing Xiang1,2,3, Dongchun Ma5, Yuan Weng6, Shilei Liu7, Chunyi Jia8, Bin Qian9, Yajia Gu3,10, Yuan Li3,11, Shaoli Song3,4, Haiquan Chen1,2,3. 1. Departments of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China. 2. Institute of Thoracic Oncology, Fudan University, Shanghai, China. 3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. 4. Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China. 5. Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, China. 6. Department of Thoracic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China. 7. Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China. 8. Department of Thoracic Surgery, Jilin Cancer Hospital, Changchun, China. 9. Department of Thoracic Surgery, Jiang Du People's Hospital, Jiangdu, China. 10. Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China. 11. Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.
Abstract
BACKGROUND: 99m Tc bone scintigraphy (BS) is still the most common approach for the evaluation of bone metastasis in China. The purpose of this study was to investigate the necessity of BS as part of a routine preoperative workup for patients with cT1N0 subsolid lung cancer. METHODS: This was a prospective multicenter clinical trial (NCT03689439). Patients with cT1N0 subsolid nodules who were candidates for surgical resection were consecutively enrolled into the study. BS was performed preoperatively. The surgical plan could be changed if a positive result was detected. The primary endpoint was the incidence rate of the surgical plan being changed because of positive BS results. The secondary endpoint was the rate of positive BS findings and the rate of related complications. RESULTS: From November 2018 to July 2019, 691 patients were enrolled into the study. None of the patients had positive BS results and no surgical plans were changed by BS findings. There were 222 male and 469 female patients. The average age was 54.8 ± 3.7 years old. The average tumor diameter was 14.9 ± 4.2 mm. There were 282 patients with pure GGO nodules and 409 with part-solid nodules. A total of 470 patients had a single nodule, while 221 patients had multifocal lesions. The number of patients whose pathological diagnosis was invasive adenocarcinoma, minimally invasive adenocarcinoma, adenocarcinoma in situ and mucinous adenocarcinoma was 357, 293, 32 and nine, respectively. The number of patients who underwent lobectomy, segmentectomy and wedge resection was 234, 199 and 258, respectively. CONCLUSIONS: 99m Tc bone scintigraphy is unnecessary in the preoperative workup for patients with cT1N0 subsolid lung cancer. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: In this prospective study of 691 patients with cT1N0 subsolid lung cancer, no surgical plans were affected by positive bone scan findings. WHAT THIS STUDY ADDS: We suggest physicians consider canceling BS from preoperative workup for cT1 subsolid lung cancer patients. Clinical trial registry number: NCT03689439.
BACKGROUND: 99m Tc bone scintigraphy (BS) is still the most common approach for the evaluation of bone metastasis in China. The purpose of this study was to investigate the necessity of BS as part of a routine preoperative workup for patients with cT1N0 subsolid lung cancer. METHODS: This was a prospective multicenter clinical trial (NCT03689439). Patients with cT1N0 subsolid nodules who were candidates for surgical resection were consecutively enrolled into the study. BS was performed preoperatively. The surgical plan could be changed if a positive result was detected. The primary endpoint was the incidence rate of the surgical plan being changed because of positive BS results. The secondary endpoint was the rate of positive BS findings and the rate of related complications. RESULTS: From November 2018 to July 2019, 691 patients were enrolled into the study. None of the patients had positive BS results and no surgical plans were changed by BS findings. There were 222 male and 469 female patients. The average age was 54.8 ± 3.7 years old. The average tumor diameter was 14.9 ± 4.2 mm. There were 282 patients with pure GGO nodules and 409 with part-solid nodules. A total of 470 patients had a single nodule, while 221 patients had multifocal lesions. The number of patients whose pathological diagnosis was invasive adenocarcinoma, minimally invasive adenocarcinoma, adenocarcinoma in situ and mucinous adenocarcinoma was 357, 293, 32 and nine, respectively. The number of patients who underwent lobectomy, segmentectomy and wedge resection was 234, 199 and 258, respectively. CONCLUSIONS: 99m Tc bone scintigraphy is unnecessary in the preoperative workup for patients with cT1N0 subsolid lung cancer. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: In this prospective study of 691 patients with cT1N0 subsolid lung cancer, no surgical plans were affected by positive bone scan findings. WHAT THIS STUDY ADDS: We suggest physicians consider canceling BS from preoperative workup for cT1 subsolid lung cancerpatients. Clinical trial registry number: NCT03689439.
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