TY - JOUR
T1 - Clinical Non–Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals
AU - Wu, Dolly Y.
AU - de Hoyos, Alberto
AU - Vo, Dat T.
AU - Hwang, Helena
AU - Spangler, Ann E.
AU - Seiler, Stephen J.
N1 - Funding Information:
We especially thank National Cancer Institute's SEER Program; UT Southwestern Medical Center Cancer Registry; UTSW Thoracic Surgery Database, Phillip Escarsega(MS); Heather Blakley(PA), Kiran Batra(MD), Yasmeen Butt(MD), H. Michael Crowson(PhD), David J. Fisher(MSc), Jeffrey Guild(PhD), Fernando Kay(MD), Mia Lv(PhD), Ayobami Odu(MBBS), Nhat-Long Pham(MD, PhD), Jason Wachsmann(MD), Kenneth Westover(MD, PhD), Charles Zaionitz(PhD). This research did not receive any specific grant from funding agencies. The retrospective patient review study protocol was approved by the UTSW Institutional Review Board (STU042018-003, with waived informed consent).
Publisher Copyright:
© 2020
PY - 2021/6
Y1 - 2021/6
N2 - Rationale and Objectives: Examine the accuracy of clinical non–small cell lung cancer staging and tumor length measurements, which are critical to prognosis and treatment planning. Materials and Methods: Compare clinical and pathological staging and lengths using 10,320 2016 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and 559 2010–2018 non-SEER single-institute surgically-treated cases, and analyze modifiable causes of disagreement. Results: The SEER clinical and pathological group-stages agree only 62.3% ± 0.9% over all stage categories. The lymph node N-stage agrees much better at 83.0% ± 1.0%, but the tumor length-location T-stage agrees only 57.7% ± 0.8% with approximately 29% of the cases having a greater pathology than clinical T-stage. Individual T-stage category agreements with respect to the number of pathology cases are Tis, T1a, T1b, T2a, T2b, T3, T4: 89.9% ± 10.0%; 78.7% ± 1.7%; 51.8% ± 1.9%; 46.1% ± 1.3%; 40.5% ± 3.1%; 44.1% ± 2.2%; 56.4% ± 4.7%, respectively. Most of the single-institute results statistically agree with SEER's. Excluding Tis cases, the mean difference in SEER tumor length is ∼1.18 ± 9.26 mm (confidence interval: 0.97–1.39 mm) with pathological lengths being longer than clinical lengths except for small tumors; the two measurements correlate well (Pearson-r >0.87, confidence interval: 0.86–0.87). Reasons for disagreement include the use of family-category descriptors (e.g., T1) instead of their subcategories (e.g., T1a and T1b), which worsens the T-stage agreement by over 15%. Disagreement is also associated with higher tumor grade, larger resected specimens, higher N-stage, patient age, and periodic biases in clinical and pathological tumor size measurements. Conclusions: By including preliminary non–small cell lung cancer clinical stage values in their evaluation, diagnostic radiologists can improve the accuracy of staging and standardize tumor-size measurements, which improves patient care.
AB - Rationale and Objectives: Examine the accuracy of clinical non–small cell lung cancer staging and tumor length measurements, which are critical to prognosis and treatment planning. Materials and Methods: Compare clinical and pathological staging and lengths using 10,320 2016 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and 559 2010–2018 non-SEER single-institute surgically-treated cases, and analyze modifiable causes of disagreement. Results: The SEER clinical and pathological group-stages agree only 62.3% ± 0.9% over all stage categories. The lymph node N-stage agrees much better at 83.0% ± 1.0%, but the tumor length-location T-stage agrees only 57.7% ± 0.8% with approximately 29% of the cases having a greater pathology than clinical T-stage. Individual T-stage category agreements with respect to the number of pathology cases are Tis, T1a, T1b, T2a, T2b, T3, T4: 89.9% ± 10.0%; 78.7% ± 1.7%; 51.8% ± 1.9%; 46.1% ± 1.3%; 40.5% ± 3.1%; 44.1% ± 2.2%; 56.4% ± 4.7%, respectively. Most of the single-institute results statistically agree with SEER's. Excluding Tis cases, the mean difference in SEER tumor length is ∼1.18 ± 9.26 mm (confidence interval: 0.97–1.39 mm) with pathological lengths being longer than clinical lengths except for small tumors; the two measurements correlate well (Pearson-r >0.87, confidence interval: 0.86–0.87). Reasons for disagreement include the use of family-category descriptors (e.g., T1) instead of their subcategories (e.g., T1a and T1b), which worsens the T-stage agreement by over 15%. Disagreement is also associated with higher tumor grade, larger resected specimens, higher N-stage, patient age, and periodic biases in clinical and pathological tumor size measurements. Conclusions: By including preliminary non–small cell lung cancer clinical stage values in their evaluation, diagnostic radiologists can improve the accuracy of staging and standardize tumor-size measurements, which improves patient care.
KW - Accuracy
KW - Clinical and pathological staging
KW - Lung cancer staging
KW - Tumor length
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U2 - 10.1016/j.acra.2020.04.007
DO - 10.1016/j.acra.2020.04.007
M3 - Article
C2 - 32563559
AN - SCOPUS:85086570280
VL - 28
SP - 753
EP - 766
JO - Academic Radiology
JF - Academic Radiology
SN - 1076-6332
IS - 6
ER -