Comparison of imaging TNM [(i)TNM] and pathological TNM [pTNM] in staging of bronchogenic carcinoma

Gdeedo, A; Schil, Paul Van; Corthouts, B.; Mieghem, François Van; Meerbeeck, Jan Van; Marck, E. Van

doi:10.1016/s1010-7940(97)00084-5

Cited by 110 publications

(51 citation statements)

References 16 publications

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“…Nonetheless, multislice CT scan showed a 60.0% positive predictive value in assessing tumor spread to proximal vessels. This result is similar to that reported in previous studies employing conventional CT [7][8][9][10][11], while it is somewhat worst than that reported in one study by thin-section electron-beam CT [26] in which accuracy, sensitivity, and specificity in evaluating invasion of the pulmonary artery were 75%, 77.8%, and 71.4%, respectively. It is worth noting that, in this study, if one considers left-sided FVP only, negative predictive value was 100%, which suggests a high accuracy in detecting resectable lesions in these patients.…”

Section: Commentsupporting

confidence: 90%

Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

Pompeo

Tacconi

Mineo

2007

The Annals of Thoracic Surgery

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Background. The purpose of this study was to evaluate feasibility and effectiveness of flexible videopericardioscopy (FVP) in assessing resectability of cT4 nonsmall-cell lung cancer (NSCLC) with radiologic evidence of proximal vascular invasion.Methods. Between March 2003 and December 2005, 22 patients with NSCLC deemed unresectable owing to signs of proximal vascular invasion at multislice computed tomography were included in a nonrandomized prospective study entailing FVP performed before curative-intent thoracotomy. Primary outocome measures were technical feasibility (graded from 1 ‫؍‬ poor to 3 ‫؍‬ excellent) and quality of anatomic visualization (graded as diagnostic or nondiagnostic). Patients with FVP evidence of proximal vascular invasion did not receive thoracotomy and were included in an induction chemoradiotherapy protocol.Results. Mean operative time was 31 ؎ 6 minutes. Technical feasibility ranged from good to excellent in 21 patients. In 1 patient, FVP was not completed owing to

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Section: Commentsupporting

confidence: 90%

Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

Pompeo

Tacconi

Mineo

2007

The Annals of Thoracic Surgery

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“…No distant metastases M1 Distant metastases present one-half of the TNM stages derived from CT agree with operative staging, with patients being both under and over staged [91,92]. However, quick access to investigation, high histological confirmation rates (at bronchoscopic/transthoracic biopsy or at thoracotomy), routine CT scanning and review of every patient by a thoracic surgeon is known to substantially increase successful surgical resection [93].…”

Section: M0mentioning

confidence: 89%

“…MCLOUD et al [103] also found that 37% of nodes, which were 2-3 cm in diameter, did not contain metastases at thoracotomy. More recently in a study of hila and mediastinal nodes at CT compared to pathological examination, sensitivities and specificities for metastatic involvement were only 48% and 53% with an overall accuracy of 51% [92]. Despite these statistics, CT is still recommended as the standard strategy for the investigation of lung cancer by the Canadian Lung Oncology Group [109] after the study of 685 patients, CT and mediastinoscopy in all patients proving too expensive.…”

Section: Nodal Statusmentioning

confidence: 99%

Diagnostic imaging of lung cancer

Hollings¹,

Shaw²

2002

Eur Respir J

124

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Carcinoma of the bronchus is the most common malignancy in the Western world. It is also the leading cause of cancer-related death accounting for 32% of all cancer deaths in males and 25% in females [1]. In the USA it causes more deaths than cancers of the colon, breast and prostate combined [2]. Disappointingly, in a recent UK survey of improvements in cancer survival [3], carcinoma of the bronchus showed the smallest percentage reduction in the number of deaths avoided between 1981-1990 (0.2%). This compares badly with breast (11% reduction) and melanoma (32%). The overall 5-yr survival for lung cancer diagnosed between 1986-1990 was only 5.3% (against 66% for breast and 76% for melanoma). It is on this background that the radiologist remains actively employed in the detection, diagnosis, staging and review of this common malignancy.

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“…Cangemi et al (2) report an accuracy of 91% and 27% for the staging of T 3 and T 4 lung cancers, respectively, with the use of chest computerized tomography (CT). Gdeedo et al (3) report that overall, CT staging for T 3 or T 4 lung cancers was correct only 50% of the time. Comparisons of clinical and pathologic staging generally show that clinical staging underestimates the true pathologic stage.…”

Section: Stagingt 3 and T 4 Lung Cancermentioning

confidence: 99%

Surgical Management of T3 and T4 Lung Cancer

DiPerna

Wood

2005

Clinical Cancer Research

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Locally advanced lung cancer (T 3 or T 4 ) has a significantly worse prognosis than lower stage disease. However, this diagnosis is usually made radiologically, and experienced thoracic surgeons are familiar with the low radiologic to pathologic correlation in tumors that abut the great vessels, mediastinum, or chest wall. Commonly these tumors do not directly invade adjacent structures and are, in fact,T 1 orT 2 tumors that are resectable through standard techniques. Where there is no clearly evident invasion of unresectable structures, the patient should be given the benefit of the doubt and considered at a lower (resectable) stage until proven otherwise. The curability of T 3 tumors varies according to the involved site. A T 3 N 0 tumor involving the chest wall provides the most favorable prognosis among the resected T 3 lesions, with a 5-year survival of >50% in lymph node^negative patients if resection is complete. Palliative incomplete resections of T 4 disease, in which tumor has invaded mediastinal structures, have not shown any survival benefit and are associated with very high morbidity and mortality. However, patients with limited invasion of the carina, left atrium, superior vena cava, or pulmonary artery may be able to be completely resected despite their T 4 classification. Surgical resection remains an important part of the therapy for patients with locally advanced lung cancer. Modern techniques of chest wall resection and reconstruction and bronchoplastic procedures allow complete resection of locally advanced tumors with favorable 5-year survival rates and low morbidity and mortality.

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Comparison of imaging TNM [(i)TNM] and pathological TNM [pTNM] in staging of bronchogenic carcinoma

Abstract: Even with present-day CT scanners (i)TNM provides no accurate staging and routine mediastinoscopy is necessary for precise mediastinal lymph node staging. Likewise, (i)T3 and (i)T4 determinations are unreliable and should not contraindicate thoracotomy.

Cited by 110 publications

References 16 publications

Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

Diagnostic imaging of lung cancer

Surgical Management of T3 and T4 Lung Cancer

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