Pathologic node-negative lung cancer: Adequacy of lymph node yield and a tool to assess the risk of occult nodal disease Journal Article

   


Authors: Tan, K. S.; Hsu, M.; Adusumilli, P. S.
Article Title: Pathologic node-negative lung cancer: Adequacy of lymph node yield and a tool to assess the risk of occult nodal disease
Abstract: Introduction: Accurate lymph node (LN) staging is crucial for prognostication in NSCLC. Diagnosis of pN0 disease is based on the absence of positive LNs, irrespective of the number of LNs excised, and is thus susceptible to sampling error. Tumors that are assumed to be pN0 may in fact be understaged. We developed a tool to quantify the risk of occult nodal disease (OND) among patients with pN0 NSCLC in terms of the number of LNs examined. Methods: Patients treated surgically for stage I-III primary NSCLC between 2004 and 2014 (n = 49,356) were extracted from the Surveillance, Epidemiology, and End Results database. The probability of missing a positive node in terms of the number of LNs examined was modeled using a beta-binomial model. A mathematical tool was then used to calculate the negative predictive value (NPV) corresponding to the number of LNs examined. Ranging from 0 to 100%, higher NPV reflects greater confidence in the pN0 diagnosis and a lower probability of OND. Results: The median number of LNs examined was 7 for N0, 10 for N1/N2, and 8 for N3 disease. The probability of missing a positive node decreased as LNs examined increased. Additionally, higher T stage required more LNs to confirm an N0 diagnosis. After accounting for false-negative diagnoses, the prevalence of node-positive disease was readjusted from 16% to 22% among patients with T1 disease. According to our tool, with 10 LNs examined, the NPV was 85% (15% probability of OND) for a patient with T3 disease, compared with 95% (5% probability of OND) for a patient with T1 disease. Conclusions: Accurate pN0 diagnosis depends on the number of LNs examined. The proposed tool offers the ability to quantify, in a patient-specific manner, the confidence in a diagnosis of node-negative disease on the basis of the number of LNs examined. © 2022 Elsevier B.V.
Keywords: adult; cancer survival; controlled study; human tissue; aged; major clinical study; cancer staging; lymph node metastasis; diagnostic accuracy; sensitivity and specificity; lymphadenectomy; pneumonectomy; prevalence; cohort analysis; risk assessment; false negative result; cancer registry; negative predictive value; lymphatic system examination; predictive value; mathematical analysis; non small cell lung cancer; nodal metastasis; seer; cancer prognosis; human; male; female; article; lymph node examination; adequate lymph node evaluation; occult nodal disease
Journal Title: Lung Cancer
Volume: 174
ISSN: 0169-5002
Publisher: Elsevier Ireland Ltd.  
Date Published: 2022-12-01
Start Page: 60
End Page: 66
Language: English
DOI: 10.1016/j.lungcan.2022.10.004
PUBMED: 36334358
PROVIDER: scopus
PMCID: PMC10103231
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85141263185&doi=10.1016%2fj.lungcan.2022.10.004&partnerID=40&md5=3c3433233cea18eca0dc921d29fb579f
Notes: Article -- Export Date: 1 December 2022 -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Meier Hsu
    169 Hsu
  2. Prasad S Adusumilli
    496 Adusumilli
  3. Kay See Tan
    241 Tan
Related MSK Work