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New CT criteria for nodal staging in non-small cell lung cancer

  • Satoshi Kudo
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Kazuhiro Imai
    Correspondence
    Corresponding author. Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan. Tel.: +81 18 884 6132; fax: +81 18 836 2615.
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Kouichi Ishiyama
    Affiliations
    Department of Integrated Medicine, Division of Radiology and Radiation Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Manabu Hashimoto
    Affiliations
    Department of Integrated Medicine, Division of Radiology and Radiation Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Hajime Saito
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Satoru Motoyama
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Yusuke Sato
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Shinogu Takashima
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Katsuyuki Murata
    Affiliations
    Department of Environmental Health Sciences, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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  • Yoshihiro Minamiya
    Affiliations
    Department of General Thoracic Surgery (and Breast and Endocrine Surgery), Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City 010–8543, Japan
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Published:February 18, 2014DOI:https://doi.org/10.1016/j.clinimag.2014.02.008

      Abstract

      Objective

      The purpose of our study was to develop a simple noninvasive technique for nodal staging using routine preoperative computed tomography (CT).

      Materials and methods

      The institutional review board approved this retrospective study, and written informed consent to perform the initial and follow-up CT studies was obtained from all patients. Preoperative CT findings (n=218 patients with resectable non-small cell lung cancer) and pathological diagnoses after surgical resection were evaluated. Using CT images, lymph node section area, circumference, and lesion attenuation values (LAVs) were drawn freehand, and the short axis (SA) and long axis (LA) were measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze the section area, circumference, and LAVs.

      Results

      Based on ROC curves, two cut-off values, lymph node section area >30 mm2 and circumference >25 mm, showed greater sensitivity for nodal staging than the conventional criterion of lymph node SA ≥10 mm or the LA, SA/LA ratio or LAVs. Using lymph node section area >30 mm2 for diagnosis, the sensitivity, specificity, and accuracy of nodal staging were 90.5%, 56.3%, and 58.3%, respectively. Using lymph node circumference >25 mm, the values were 76.2%, 70.4%, and 70.8%, respectively.

      Conclusion

      Lymph node section area >30 mm2 and circumference >25 mm can serve as supportive criteria used by radiologists and surgeons to determine nodal staging. If these CT criteria are met, use of a more sensitive procedure such as positron emission tomography or mediastinoscopy is recommended.

      Concise abstract

      CT is used routinely during preoperative management of lung cancer. Based on ROC analyses, the cut-off values for surface area, circumference, the SA/LA ratio, and LAVs for diagnosis of lymph node metastasis were 30 mm2, 25 mm, 0.65, and 50 Hounsfield units, respectively. Our findings indicate that lymph node surface area >30 mm2 and circumference >25 mm are supportive criteria that can be used by radiologists and thoracic surgeons to determine nodal staging and surgical indications.

      Keywords

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