Preoperative Contrast-enhanced CT Features Associated with Occult Lymph Node Metastasis in Early-Stage Solid...

Area of Science:

• Radiology and Oncology
• Thoracic Surgery

Background:

• Occult lymph node metastasis (OLNM) is a critical factor in early-stage non-small cell lung cancer (NSCLC).
• Accurate preoperative identification of OLNM is essential for guiding individualized lymph node dissection (LND) strategies.

Purpose of the Study:

• To develop and validate a contrast-enhanced CT-based prediction model for identifying OLNM in early-stage NSCLC.
• To support tailored LND strategies based on CT imaging predictors.

Main Methods:

• Retrospective study of 329 patients with clinical stage I-IIA solid NSCLC undergoing lobectomy and LND.
• Logistic regression analysis to identify CT predictors of OLNM and construct a nomogram.
• Model performance evaluated using receiver operating characteristic curve analysis.

Main Results:

• 22.2% of patients had OLNM, with 47.9% N1 and 52.1% N2 involvement.
• Independent CT predictors included decreased inner margin ratio, lollipop sign, and tumor-pleura relationship types II and III.
• The nomogram achieved an AUC of 0.81, with 78.1% sensitivity and 73.4% specificity.

Conclusions:

• A contrast-enhanced CT-based nomogram effectively stratifies preoperative risk for OLNM in early-stage solid NSCLC.
• The model incorporates key imaging features to aid in personalized LND strategies.
• This tool has the potential to optimize surgical planning for NSCLC patients.