Discrepancies between radiological whole tumor size (RTS) and pathological whole tumor
size (PTS) are sometimes observed. Unexpected pathological upsize may lead to insufficient
margins during procedures like sub lobar resections. Therefore, this study aimed to
investigate the current status of these discrepancies and identify factors resulting
in pathological upsize in patients with early-stage non-small cell lung cancer (NSCLC).
Data from a multicenter database of 3092 patients with clinical stage 0-IA NSCLC who
underwent pulmonary resection were retrospectively analyzed. Differences between the
RTS and PTS were evaluated using Pearson's correlation analysis and Bland-Altman plots.
Unexpected pathological upsize was defined as an upsize of ≥1 cm when compared to
the RTS, and the predictive factors of this upsize were identified based on multivariable
analyses. The RTS and PTS showed a positive linear relationship (r = 0.659), and the RTS slightly overestimated the PTS. The Bland-Altman plot showed
131 of 3092 (5.2%) cases were over the upper 95% limits of agreement. In multivariable
analyses, a maximum standardized uptake value (SUVmax) of the primary tumor on 18-fluoro-2-deoxyglucose positron emission tomography/computed
tomography (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.035−1.107; P < 0.001) and the adenocarcinoma histology (OR, 1.899; 95% CI, 1.071−3.369; P =0.049) were independent predictors of unexpected pathological upsize. More of the
adenocarcinomas with pathological upsize were moderately or poorly differentiated,
when compared to those without. The RTS tends to overestimate the PTS; however, care
needs to be taken regarding unexpected pathological upsize, especially in adenocarcinomas
with a high SUVmax.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
Ad (adenocarcinoma), AIS (adenocarcinoma in situ), IMA (invasive mucinous adenocarcinoma), CALGB (Cancer and Leukemia Group B), CI (confidence interval), CT (computed tomography), EGFR (epidermal growth factor receptor), FDG-PET/CT (18 fluoro-2-deoxyglucose positron emission tomography/computed tomography), GGO (ground-glass opacity), HU (Hounsfield units), IQR (interquartile range), JCOG (Japanese Clinical Oncology Group), LLL (left lower lobe), LUL (left upper lobe), MIA (minimally invasive adenocarcinoma), NSCLC (non-small cell lung cancer), PTS (pathological whole tumor size), RLL (right lower lobe), RML (right middle lobe), RTS (radiological whole tumor size), RUL (right upper lobe), SD (standard deviation), SqCC (squamous cell carcinoma), SUVmax (maximum standardized uptake value), WJOG (West Japan Oncology Group)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 09, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosures: The authors have no conflicts of interest to declare.
IRB approval: The Institutional Review Boards of participating institutions approved this retrospective review (Hiroshima University Hospital: June 13, 2018; E-1216, Kanagawa Cancer Center: February 28, 2013; 24-KEN-54, Tokyo Medical University Hospital: February 25, 2015; SH2969).
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