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

Dong Woog Yoon ¹, Danbee Kang ^2,3, Yeong Jeong Jeon ⁴

⁰Department of Thoracic and Cardiovascular Surgery, Chungang-University Hospital, Seoul, South Korea.

European Radiology +

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June 8, 2024

View abstract on PubMed

Summary

Radiologic characteristics on CT scans can predict occult lymph node metastasis (OLNM) in non-small cell lung cancer (NSCLC). Endobronchial tumors show the highest risk, aiding in selecting patients for nodal staging and dissection.

Area Of Science

Oncology
Radiology
Thoracic Surgery

Background

Occult lymph node metastasis (OLNM) is common in resectable non-small cell lung cancer (NSCLC) despite current guidelines.
Accurate assessment of OLNM is crucial for prognostication and treatment planning.

Purpose Of The Study

To evaluate the predictive value of primary tumor radiologic characteristics on computed tomography (CT) for OLNM risk in NSCLC patients.
To identify specific CT features associated with an increased likelihood of OLNM.

Main Methods

Retrospective review of 2042 NSCLC patients (T1-4N0) who underwent curative resection.
Analysis of unique radiological features (air-bronchogram, GGO, cystic appearance, endobronchial location), solid portion percentage, and tumor margin shape.
Multivariable logistic regression to determine the association between tumor characteristics and OLNM.

Main Results

Endobronchial tumors demonstrated the highest association with OLNM (OR=3.9).
Heterogeneous ground-glass opacity (GGO) and mainly cystic tumors were linked to a lower risk of OLNM.
Solid tumors (OR=2.49), spiculated margins, and peritumoral GGO in part-solid tumors (>50% solid) were associated with OLNM.

Conclusions

CT-based radiologic characteristics can effectively assess OLNM risk in NSCLC.
These findings can guide the selection of optimal candidates for invasive nodal staging procedures (INSPs) and lymph node dissection.
This approach supports personalized treatment strategies for NSCLC patients.

Keywords:

Diagnostic imaging Lung cancer Lymph node metastasis

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