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08-06-2024 | Chest

Computed tomography characteristics of cN0 primary non-small cell lung cancer predict occult lymph node metastasis

Authors: Dong Woog Yoon, Danbee Kang, Yeong Jeong Jeon, Junghee Lee, Sumin Shin, Jong Ho Cho, Yong Soo Choi, Jae Ill Zo, Jhingook Kim, Young Mog Shim, Juhee Cho, Hong Kwan Kim, Ho Yun Lee

Published in: European Radiology

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Abstract

Rationale

Occult lymph node metastasis (OLNM) is frequently found in patients with resectable non-small cell lung cancer (NSCLC), despite using diagnostic methods recommended by guidelines.

Objectives

To evaluate the risk of OLNM in NSCLC patients using the radiologic characteristics of the primary tumor on computed tomography (CT).

Methods

We retrospectively reviewed clinicopathologic features of 2042 clinical T1-4N0 NSCLC patients undergoing curative intent pulmonary resection. Unique radiological features (i.e., air-bronchogram throughout the whole tumor, heterogeneous ground-glass opacity (GGO), mainly cystic appearance, endobronchial location), percentage of solid portion, and shape of tumor margin were analyzed via a stepwise approach. We used multivariable logistic regression to assess the relationship between OLNM and tumor characteristics.

Results

Compared with the other unique features, endobronchial tumors were associated with the highest risk of OLNM (OR = 3.9, 95% confidence interval (CI) = 2.29–6.62), and heterogeneous GGO and mainly cystic tumors were associated with a low risk of OLNM. For tumors without unique features, the percentage of the solid portion was measured, and solid tumors were associated with OLNM (OR = 2.49, 95% CI = 1.86–3.35). Among part-solid tumors with solid proportion > 50%, spiculated margin, and peri-tumoral GGO were associated with OLNM.

Conclusions

The risk of OLNM could be assessed using radiologic characteristics on CT. This could allow us to adequately select optimal candidates for invasive nodal staging procedures (INSPs) and complete systematic lymph node dissection.

Clinical relevance statement

These data may be helpful for clinicians to select appropriate candidates for INSPs and complete surgical systematic lymph node dissection in NSCLC patients.

Key Points

  • Lymph node metastasis status plays a key role in both prognostication and treatment planning.
  • Solid tumors, particularly endobronchial tumors, were associated with occult lymph node metastasis (OLNM).
  • The risk of OLNM can be assessed using radiologic characteristics acquired from CT images.
Appendix
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Metadata
Title
Computed tomography characteristics of cN0 primary non-small cell lung cancer predict occult lymph node metastasis
Authors
Dong Woog Yoon
Danbee Kang
Yeong Jeong Jeon
Junghee Lee
Sumin Shin
Jong Ho Cho
Yong Soo Choi
Jae Ill Zo
Jhingook Kim
Young Mog Shim
Juhee Cho
Hong Kwan Kim
Ho Yun Lee
Publication date
08-06-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10835-z