Efficacy of chest computed tomography prediction of the pathological TNM stage of thymic epithelial tumours†

Abstract

OBJECTIVES The aim of this study is to evaluate the efficacy of chest computed tomography (CT) to predict the pathological stage of thymic epithelial tumours (TET) using the recently introduced tumour, node and metastasis (TNM) staging with comparison to the modified Masaoka staging. METHODS Preoperative chest CT examinations in cases of resected TET with sampled lymph nodes (2006–2016) were retrospectively reviewed by 2 thoracic radiologists and radiologically (r) staged using both staging systems. A thoracic pathologist reviewed all cases for the pathological (p) stage. Concordance between r-staging and p-staging was assessed by % agreement and unweighted kappa statistics. Associations between r-stage and p-stage with outcomes were assessed using the Cox proportional hazards regression. RESULTS Sixty patients with TET were included (47 thymomas, 12 thymic carcinomas and 1 atypical carcinoid tumour). Sixteen patients (26.7%) had received neoadjuvant therapy. Fifty-four patients (90.0%) had complete resection. The overall agreement between the r-stage and p-stage was 66.7% (κ = 0.46) for TNM staging and 46.7% (κ = 0.30) for modified Masaoka staging. Agreement between r-assessment and p-assessment of the T, N and M components of the TNM stage was 61.7% (κ = 0.28), 86.7% (κ = 0.48) and 98.3% (κ = 0.88), respectively. CT overstaged 12 patients (20.0%) for TNM staging and 12 patients (20.0%) for modified Masaoka staging and understaged 8 (13.3%) and 20 (33.3%) patients for TNM staging modified Masaoka staging, respectively. The r-TNM staging accuracy was lower for patients with neoadjuvant therapy (50.0% with vs 72.7% without). During a median follow-up of 2.6 years (range 0.1–10.5 years), 12 patients had metastases and/or recurrence; 11 patients died (4 of disease). The r-TNM stage and modified Masaoka stage were associated with overall survival and progression-free survival (P < 0.001). CONCLUSIONS Preoperative chest CT is able to accurately predict p-TNM stage in two-thirds of surgically resected TET, with an agreement between radiological staging and pathological staging superior to the modified Masaoka staging.

Timik Tümörlerin Sistemik Tedavisinde Gelişmeler

“…Bilgisayarlı Tomografide (BT) timik karsinomlar timomalardan farklı olarak sıklıkla nekrotik, kistik veya kalsifiye alanlar içerirler ve tümör kontürü irregülerdir. Timomalarda ise tümör kontürü daha düzdür (10). Manyetik Rezonans (MR) sinyal paternleri ayırıcı tanıda önemli olabilir.…”

Robotic thymectomy for advanced thymic epithelial tumor: indications and technical aspects

“…In patients with an anterior mediastinal mass suspected to be advanced TET, complete preoperative evaluation is needed, mainly to determine whether the mass is resectable or not. High-quality, contrast-enhanced thoracic computed tomography (CT) remains the mainstay preoperative imaging technique to determine whether complete resection is feasible (18)(19)(20). The CT scans can determine the size of the TET, evaluate the mass for signs of local invasion, and rule out metastatic disease (18)(19)(20).…”

“…High-quality, contrast-enhanced thoracic computed tomography (CT) remains the mainstay preoperative imaging technique to determine whether complete resection is feasible (18)(19)(20). The CT scans can determine the size of the TET, evaluate the mass for signs of local invasion, and rule out metastatic disease (18)(19)(20). In particular, contrast-enhanced CT must be performed to examine the relationship between the adjacent major vascular structures and TET.…”

On the staging of thymic epithelial neoplasms

“…The recent article by White et al in the European Journal of Cardiothoracic Surgery on the efficacy of chest computed tomography prediction of the pathological TNM stage of thymic epithelial tumors ( 1 ) underscores an issue that has impacted the field of thymoma studies, namely what is the proper way for staging such tumors. The study by White et al ( 1 ) shows that preoperative chest CT is able to accurately predict p-TNM stage in only two thirds of surgically resected thymic epithelial tumors.…”

“…The recent article by White et al in the European Journal of Cardiothoracic Surgery on the efficacy of chest computed tomography prediction of the pathological TNM stage of thymic epithelial tumors ( 1 ) underscores an issue that has impacted the field of thymoma studies, namely what is the proper way for staging such tumors. The study by White et al ( 1 ) shows that preoperative chest CT is able to accurately predict p-TNM stage in only two thirds of surgically resected thymic epithelial tumors. Thus, one third of patients will have false positives or false negatives that may adversely affect the management options for those patients, including decisions of whether to offer preoperative radiation that may lead to incomplete surgical resections or overtreatment of the lesions with added morbidity.…”