Mediastinal lymphnode positivity clinical scoring system for lung adenocarsinoma-mediastinal lymph node evaluation and staging

Year 2022, Volume: 5 Issue: 3, 831 - 838, 30.05.2022

İsmail Ağababaoğlu Ozgur Omer Yildiz Dilek Yapar Hasan Ersöz Seray Hazer Özant Helvacı Selim Şakir Erkmen Gülhan Nurettin Karaoglanoglu

https://doi.org/10.32322/jhsm.1061755

Abstract

Aim: The study-cohort aims to assess PET-CT's correlation with adenocarcinomas' subtypes and propose a scoring system for mediastinal lymph nodes staging.
Material and Method: The patient cohort is a multicenter, retrospective analysis of 268 patient that underwent surgery for NSCLC adenocarcinoma. Preoperative PET-CT results for mediastinal lymph node staging was pathologically confirmed on tissue specimens obtained at anatomical resection. Statistical evaluation of PET CT, radiological and pathological outcomes were performed on all subgroups.
Results: The low FDG affinity in the lepidic pattern was statistically significant in the study (p <0.001). Among all cases, 65 had an increase in the disease stage to 3B. According to the multivariate logistic regression analysis, Stage 3 disease (OR=2.7), SUV max ≥6.85 (OR=2.1), lepidic type disease (OR=2.6), and tumor size ≥31 mm (OR=2.2) were found to be independently associated with post-op stage 3B disease. Based on their respective odds ratios, points were assigned to each item ranging from 2 to 3. AUC of the scoring system to diagnose post-op stage 3B disease was 0.753 (0.686-0.819), p<0.001. The optimal threshold was ≥4 points; this yielded a sensitivity of 80%, a specificity of 64%, a positive likelihood ratio of 2.2, and a diagnostic odds ratio of 7 (95% CI=3.5-13.6).
Conclusion: The lepidic subtype of adenocarcinomas could have a lower FDG affinity. The MLP scoring system based on SUVmax, tumor size, pathological subtype and cancer stage could help the clinicians to evaluate the mediastinal staging in NSCLC Adenocarcinomas accurately.

Keywords

Lung Cancer, Adenocarcinomas, Mediastinal Staging, Pozitron Emission Tomography

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