The clinical staging of lung cancer, especially stage ⅢA, provides important information for clinical analysis and treatment method to surgeon or radiation oncologist. The aim of this analysis is to evaluate of difference between clinical
staging
and
pathologic staging and determine to accuracy or preoperative pathologic diagnosis and clinical staging for clinically stage ⅢA NSCLC.
Analysis was performed on 138 patients who has been stage ⅢA NSCLC. Pathologic diagnosis was performed using sputum cytology, bronchoscopy or percutaneous needle aspiration. All patients were evaluated by CT and staged according to American
Joint
Committee on Cancer staging classification. All patients received the thoracotomy.
The pathologic diagnosis was changed after surgery in 9 patients(6.5%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in distinguishing T3 from T1-T2 were 62.5%, 89.7%, 47.6%, 87.5%, and
75.3%,
respectively. The sensitivity, specificity positive predictive value, negative predictive value, and accuracy of CT in distinguishing N2 from N0-N1 were 91.8%, 24.3%, 42.7%, 78.3%, and 54.8% respectively. According to pathologic staging, there
were
27(19.6%) patients in stage I, 24(17.4%) in stage Ⅱ, 64(46.4%) in stage ⅢA, 21(15.2%) in stage ⅢB, and 2(1.5%) in stage Ⅳ. Comparing clinical staging with pathologic staging, concordant results were found in 46.4%, 37.0% were clinically
overestimated and 16.7% underestimated.
Preoperative pathologic diagnosis was well correlate postoperative pathologic finding. But Ct accuracy was low in both primary tumor and mediastinal lymph node. Especially to diagnose malignant involvement of mediastinal nodes, CT is not a valid
means.
Patients would not be denied the opportunity for curative surgery on the basis of CT signs.
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