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Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group

2022; Elsevier BV; Volume: 101; Issue: 6 Linguagem: Inglês

10.1016/j.cireng.2022.06.006

2173-5077

Iker Lopez, Borja Aguinagalde, Iratxe Urreta, Íñigo Royo, Sergio Bolufer, Laura Sánchez, Jon Zabaleta, Arantza Fernández-Monge, José Luis Recuero Díaz, Julio Sesma, Sergio Amor, Javier Moradiellos, Miguel Jesús Arrarás, Ana Isabel Blanco, Marc Boada, David Sánchez-Lorente, Alberto Cabañero-Sánchez, Nicolás Moreno‐Mata, Isabel Cal, Ramón Moreno, Ángel Cilleruelo Ramos, Silvana Crowley, David Gómez, Elena Fernández, Florentino Hernando, Santiago García, Cipriano López, María Dolores García García, José Molero, José Eduardo Rivo, Jose Alberto Garcia, Juan José Gelbenzu, María E. Ramírez, Carlos Fernando Giraldo, Roberto Mongil, María Teresa Gómez, Marcelo F. Jiménez, Jorge Henández, Juan J. Fibla, Jennifer D. Illana, Alberto Jauregui, Unai Jiménez, Rafael Rojo, Néstor J. Martínez, Elisabeth Martínez, Juan Trujillo, Lucía Milla Collado, Sergio B. Moreno, Miguel Congregado, Carme Obiols, Sergi Call, Florencio Quero‐Valenzuela, Ricard Ramos, Alberto Rodríguez-Fuster, Carlos Simón, Raúl Embún Flor,

Pleural and Pulmonary Diseases

The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS).A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm.The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed.CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.