Division of Thoracic Surgery, University of Alabama, Birmingham, Birmingham, Alabama.
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Ann Thorac Surg. 2018 Nov;106(5):1492-1498. doi: 10.1016/j.athoracsur.2018.05.045. Epub 2018 Jun 15.
Our objective was to compare the clinical to the pathologic stage in patients with non-small cell lung cancer (NSCLC).
A prospective database from 1 surgeon was reviewed. Patients had NSCLC, chest tomography (CT), and most had positron emission tomography (PET). Those with suggested N1, N2, central tumors, or tumors larger than 5 cm underwent mediastinoscopy or endobronchial ultrasound, or both, and if N2 negative, underwent resection with complete thoracic lymphadenectomy.
Between January 2006 and December 2016, there were 1,444 consecutive patients. The sensitivity and specificity for CT was 76% and 79% for pathologic stage I, 48% and 89% for stage II, and 58% and 88% for stage III. The sensitivity and specificity for PET was 77% and 70% for pathologic stage I, 43% and 88% for stage II, and 46% and 93% for stage III. Pathologic N1 disease was proven in 7% of patients and missed in 4% by CT, 5% by PET, and 3% by both. Pathologic N2 disease was proven in 20% of patients and missed in 9% by CT, 10% by PET, and 8% by both. Occult N2 disease was present in 10% of clinically stage I patients and in 21% of clinically stage II patients. Independent predictors of occult N1 disease included high maximum standardized uptake value (p = 0.034) and predictors of N2 disease included African American race (p = 0.020) and large tumor size (p = 0.047).
Despite advancements in CT, PET, and minimally invasive nodal biopsy, there remains significant NSCLC misstaging, especially for N2 disease. Improved, targeted N2 lymph node biopsy may improve preresection staging.
本研究旨在比较非小细胞肺癌（NSCLC）患者的临床分期和病理分期。
回顾 1 位外科医生的前瞻性数据库。患者患有 NSCLC，进行胸部 CT 检查，大多数患者还进行正电子发射断层扫描（PET）检查。对疑似 N1、N2、中央型肿瘤或肿瘤大于 5cm 的患者，行纵隔镜或支气管内超声检查，如 N2 阴性，则行完全性胸内淋巴结清扫术。
2006 年 1 月至 2016 年 12 月，共有 1444 例连续患者。CT 对 I 期、II 期和 III 期的病理分期的灵敏度和特异度分别为 76%和 79%、48%和 89%、58%和 88%；PET 对 I 期、II 期和 III 期的灵敏度和特异度分别为 77%和 70%、43%和 88%、46%和 93%。CT 漏诊的病理 N1 疾病占 4%，而 PET 漏诊的病理 N1 疾病占 5%，两者联合漏诊的占 3%。病理 N2 疾病占 20%，CT 漏诊的占 9%，PET 漏诊的占 10%，两者联合漏诊的占 8%。临床 I 期患者中隐匿性 N2 疾病的发生率为 10%，临床 II 期患者中隐匿性 N2 疾病的发生率为 21%。隐匿性 N1 疾病的独立预测因素包括最大标准化摄取值高（p=0.034），N2 疾病的预测因素包括非裔美国人（p=0.020）和肿瘤较大（p=0.047）。
尽管 CT、PET 和微创淋巴结活检技术不断进步，但 NSCLC 分期仍存在明显错误，尤其是 N2 疾病。改进针对 N2 淋巴结的活检方法可能会改善术前分期。
