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Stepwise flowchart for decision making on sublobar resection through the estimation of spread through air space in early stage lung cancer

 Jee Won Suh  ;  Yong Hyu Jeong  ;  Arthur Cho  ;  Dae Joon Kim  ;  Kyoung Young Chung  ;  Hyo Sup Shim  ;  Chang Young Lee 
 LUNG CANCER, Vol.142 : 28-33, 2020-04 
Journal Title
Issue Date
Adenocarcinoma of Lung / pathology* ; Adenocarcinoma of Lung / surgery ; Carcinoma, Non-Small-Cell Lung / pathology* ; Carcinoma, Non-Small-Cell Lung / surgery ; Decision Making* ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms / pathology* ; Lung Neoplasms / surgery ; Male ; Middle Aged ; Neoplasm Staging ; Pneumonectomy / methods* ; Retrospective Studies ; Risk Factors ; Software Design*
Ground glass opacity ; Lung cancer ; Sublobar resection ; Tumor spread through air space
Objectives: The sensitivity for tumor spread through air space (STAS), an independent risk factor for locoregional recurrence after sublobar resection for lung cancer, has been relatively low in frozen sections. We aimed to determine predictors with high negative predictive value for the presence of STAS and to provide the flowchart in combination with these predictors for the decision-making for sublobar resection. Materials and methods: Between July 2015 and December 2017, 387 patients who underwent surgery for non-small cell lung cancer (NSCLC) with pathologic findings of the total masses measuring ≤ 2 cm were enrolled. The lesions were divided into two groups according to presence of STAS. We compared the preoperative characteristics, operative data, and developed a flowchart for STAS prediction using receiver operator characteristic curve analysis and multivariable logistic regression. Results: The STAS-positive group (N = 111) had a significantly higher preoperative tumor size (1.70 [1.5] vs 1.50 [0.69], p < 0.001) and standardized uptake value tumor-to-liver (SUV T/L) ratio (1.40 [1.60] vs 0.60 [1.10], p < 0.001) and a significantly lower two-dimensional ground-glass opacity (GGO) percentage (35.86 [61.00] vs 78.14 [39.00], p < 0.001). Meanwhile, the STAS-negative group (N = 286) had higher lepidic predominance (41.6% vs. 1.8%, p < 0.001). We developed a flowchart for predicting STAS in combination with two-dimensional GGO percentage on computed tomography (CT), SUV T/L ratio on positron-emission CT, and lepidic predominant pattern. The sensitivity, specificity, and negative predictive value for STAS positivity were 79.3%, 68.5%, and 89.5%, respectively. Conclusions: The stepwise flowchart using two-dimensional GGO percentage on CT, maximum SUV, and lepidic predominance might be helpful in selecting patients with early NSCLC for sublobar resection.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Suh, Jee Won(서지원) ORCID logo https://orcid.org/0000-0003-0287-0651
Shim, Hyo Sup(심효섭) ORCID logo https://orcid.org/0000-0002-5718-3624
Lee, Chang Young(이창영)
Chung, Kyung Young(정경영)
Jeong, Yong Hyu(정용휴) ORCID logo https://orcid.org/0000-0002-0198-0026
Cho, Arthur Eung Hyuck(조응혁) ORCID logo https://orcid.org/0000-0001-8670-2473
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