RESUMO
OBJECTIVES: Lymph node staging in patients with non-small cell lung cancer is crucial for determining prognosis and treatment. Our objective was to evaluate the clinical- to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC and assess occurrence and distribution of occult lymph node metastases (OLM). MATERIALS AND METHODS: In a retrospective single center cohort study (nâ¯=â¯390), we analyzed all surgically treated NSCLC patients from January 2015 until April 2019. Patients were classified into sub-groups (1) mediastinal staging by PET-CT/CT-scan (IMAGE-group) or (2) invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group). Agreement between final clinical (cN) and pathological nodal stage (pN) and the presence and location of OLM are analyzed. RESULTS: Agreement between cN- and pN-stage was 86.3 % in the IMAGE-group (nâ¯=â¯117) and 50.9 % in the INVAS-group (nâ¯=â¯167). Occult N1 disease was found in 33 patients (16.6 % in cN0) of which 52 % occurred in LN-regions 12-14. Occult N2 disease was found in 20 cases (6.5 % in cN0 and 12.7 % in cN1). Combined, 23.1 % of all pre-operatively cN0-staged patients (nâ¯=â¯46/199) had OLM (pN+), of which 12.1 % (24/199) had metastases in regions 5-6 and/or 12-14. Of all patients with OLM, 50.0 % (23/46) had primary tumors ≤30â¯mm. CONCLUSION: OLM are frequently identified in clinically N0/N1 NSCLC, also in tumors <3â¯cm, and often in regions beyond reach of current staging techniques. These findings should be addressed when non-surgical treatment or sub-lobar resections are considered for early stage lung cancer.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/patologia , Estudos de Coortes , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Metástase Linfática , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos RetrospectivosRESUMO
We present a 48-year-old man who had developed a skin lesion on his big toe. In 2 years' time, the lesion had evolved from melanonychia striata to an erratic, erosive, granulomatous plaque of approximately 3,0 x 3,0 cm. Histopathological examination of 2 skin biopsies revealed a nodular melanoma. Diagnostic imaging and histopathological examination of 2 sentinel lymph node biopsies showed no signs of metastases. We performed a hallux amputation.