Author of

• 17328

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  MA10 - Facing the Real World: New Staging System and Response Evaluation in Immunotherapy (ID 393)

  • Event: WCLC 2016
  • Type: Mini Oral Session
  • Track: Radiology/Staging/Screening
  • Presentations: 1
  • Moderators:P. Kosmidis
  • Coordinates: 12/06/2016, 14:20 - 15:50, Stolz 2

  • 17334

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    MA10.06 - Centrality Definition in Non Small Cell Lung Cancer. Predictor For Occult Mediastinal Lymph Node Involvment (ID 3993)

    14:56 - 15:02  |  Author(s): J.M. Gimferrer
    • Abstract
    • Presentation
    • Slides

    Background:
    Central tumour location is considered as an independent risk factor for occult mediastinal metastases in patients with non­-small cell lung cancer (NSCLC) after negative computerized tomography (CT) and integrated positron emission tomography/CT. However, the distinction between a central and a peripheral tumour has not been codified, some authors consider any tumour in the inner­third of the hemithorax to be central, and others in the inner two­thirds. The objective of this study is to identify the best centrality tumour definition for detecting occult mediastinal metastasis.
    
    Methods:
    We retrospectively reviewed our thoracic surgery database for cases between January 2011 and December 2015. It was identified patients with potentially operable NSCLC screened by CT and PET/CT and they were classified according to tumour location in the inner third, middle third or outer third. The prevalence of occult mediastinal lymph node metastases was analysed in relation to tumour location. Statistical analysis for best centrality definition was performed. Univariable analysis was performed using the Fisher exact test and multivarible analysis using logistic regression.
    
    Results:
    A total of 359 patients with clinical operable NSCLC were included in our study. Seventy­-five (20.9%) tumours were located in the inner­third, 137 (38.2%) in the middle­third and 147 (40.9%) in the outer­third. It was detected 23 patients with N2 disease and negative TC and PET/CT, 8/38 (21.1%) in the inner­third, 6/121 (5.0%) in the middle­third and 9/122 (7.4%) in the outer­third. Defining centrality as tumour located in the inner­third of the hemithorax the incidence of occult N2 was 21.1% and 6.2% for central and peripheral tumour respectively. And defining centrality as tumour located in the inner two­thirds the incidence of occult N2 was 8.8% for central tumours and 7.4% for peripheral. Univariable analysis shows statistical differences in occult N2 involvement between central or peripheral defining central lesion as innerthird (p=0.002), but not for central definition of innternal twothirds (p=0.651). In multivariable analysis considering centrality possible defenition, histology, Clinical T factor and Clinical N1 affection, only innerthird as centrality definition was statistical significance predictor factor for occult mediastinal lymph node involvement (p= 0.027)
    
    Conclusion:
    Considering the results of our study the best definition for central tumour location is limited to the inner­third of the hemithorax. Given the low rate of occult N2 disease in the middle third location, the systematic evaluation of the mediastinum by ecobronchoscopy and/or mediastinoscopy in this group of patients is not justified.
    
    

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