1 Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2 Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
Ann Am Thorac Soc. 2017 Jan;14(1):118-123. doi: 10.1513/AnnalsATS.201607-568BC.
Accurate mediastinal staging is a cornerstone in the management of patients with lung cancer. For patients with radiographically normal mediastinum, current lung cancer guidelines recommend invasive mediastinal staging when tumors are centrally located. However, definitions of central tumors are nonspecific, and there are discrepancies among guidelines (e.g., some use the inner one-third of the hemithorax, whereas others use the inner two-thirds).
To describe the definitions of central tumors used by pulmonologists and thoracic surgeons in their practices.
An online questionnaire was e-mailed to members of the American Association for Bronchology and Interventional Pulmonology and members of the Cardiothoracic Surgery Network.
A total of 218 participants completed our survey (12% response rate). Most common definitions for central tumors were: inner one-third of the hemithorax (55%), in contact with hilar structures (29%), and inner two-thirds of the hemithorax (15%). Of note, 29% of participants chose a definition fabricated specifically for this survey and not supported by guidelines. Regarding the method to delineate the thirds of the hemithorax, 182 (84%) participants chose a system of concentric lines arising in the hilum, whereas 31 (14%) chose straight lines in the sagittal plane of the chest. We found strikingly similar responses in members of both societies.
A uniform definition of tumor centrality is currently lacking, and should be formulated. Studies using objective measurements that evaluate the ability of these different definitions of central lung tumors to predict N2 disease are needed to construct a clear and evidence-based definition.
准确的纵隔分期是肺癌患者管理的基石。对于纵隔影像学正常的患者，如果肿瘤位于中央，目前的肺癌指南建议进行有创性纵隔分期。然而，中央肿瘤的定义不明确，且指南之间存在差异（例如，有些使用胸腔的内三分之一，而有些使用内三分之二）。
描述肺科医生和胸外科医生在实践中使用的中央肿瘤定义。
向美国支气管镜检查和介入性肺病学协会以及心胸外科网络的成员发送了在线问卷。
共有 218 名参与者完成了我们的调查（12%的回复率）。最常见的中央肿瘤定义为：胸腔内三分之一（55%）、与肺门结构接触（29%）和胸腔内三分之二（15%）。值得注意的是，29%的参与者选择了专门为本次调查制定的、不被指南支持的定义。关于划分胸腔三分之一的方法，182 名（84%）参与者选择了以肺门为起点的同心线系统，31 名（14%）参与者选择了胸腔矢状面的直线。我们在两个协会的成员中发现了非常相似的反应。
目前缺乏肿瘤中央性的统一定义，应该制定一个定义。需要进行使用客观测量的研究，评估这些不同的中央肺癌肿瘤定义预测 N2 疾病的能力，以便构建一个明确的、基于证据的定义。
