Clinical and pathologic staging accuracy in patients with synchronous multiple primary lung cancers

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Synchronous multiple primary lung cancer (SMPLC) incidence is rising, affecting up to 20% of lung cancer patients.
• Accurate identification of SMPLC is critical for effective treatment and improved patient outcomes.
• This study evaluated the accuracy of staging for SMPLC patients at a tertiary care institution.

Purpose of the Study:

• To assess the accuracy of preoperative staging for patients diagnosed with synchronous multiple primary lung cancer (SMPLC).
• To identify common sources of staging errors in SMPLC.
• To highlight the clinical implications of inaccurate staging in SMPLC.

Main Methods:

• Retrospective review of lung cancer resection evaluations between January 2018 and September 2019.
• Identification of SMPLC cases using the modified Martini-Melamed criteria.
• Comparison of preoperative imaging (CT, PET-CT), clinical assessment, and histopathology reports against final multidisciplinary tumor board staging.

Main Results:

• Of 47 SMPLC patients, 38 (80.9%) were incorrectly staged.
• Computed tomography (CT) reports were most frequently inaccurate (70.2%), often under-staging.
• Positron emission tomography-CT (PET-CT) and histopathology reports also showed significant inaccuracies, leading to over-staging in some cases.

Conclusions:

• Patients with SMPLC face a high risk of incorrect treatment due to inaccurate staging reports.
• Radiographic and histopathologic staging alone is insufficient for accurate SMPLC assessment.
• Increased physician awareness of potential staging inaccuracies in SMPLC is essential.