Evaluation of staging agreement between CTNM and PTNM for lung cancer
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A series of 225 consecutive lung cancer patients were prospectively randomized into a study group (75 patients) and a control group (150 patients), and the agreement between CTNM (clinical staging) and PTNM (pathological staging) was evaluated. Radical mediastinal lymph node dissection was performed and on an average 11.5 nodes were dissected each case in the study group. Only suspected metastatic lymph nodes, 3.4 on an average, were dissected each case in the control group. CTNM classification was made according to clinical examination, chest image examination and bronchoscopy in every patient and PTNM staging was made after thoracotomy. Then the agreement of CTNM and PTNM staging was judged by Kappa value. The results showed that the Kappa value in the two groups was lower than the effective standard value of 0.4, which was poorer in the study group (Kappa=0.097) than that in the control group (Kappa=0.371). The principal influencing cause was that N was not well evaluated by CTNM. The principal manifestation of the staging inconsistency was that the stage of PTNM was advanced than that of CTNM. In the study group 43% of patients showed an increased stage and this occurred in 33% of the control group (P<0.05). The results of the study show that at present the CTNM staging has not fully satisfied the needs of practice and requires to be further improved. The operative procedure that only suspected involved mediastinal lymph nodes are dissected can not meet the needs of PTNM staging. In order to make PTNM staging accurately and evaluate the results of treatment for lung cancer, radical mediastinal lymph node dissection should be performed in every operable patient.
Key wordsPulmonary neoplasms Cancer staging Lymph node excisin
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