Consolidation/Tumor Ratio on Chest Computed Tomography as Predictor of Postoperative Nodal Upstaging in Clinical T1N0 Lung Cancer

  • Youngkyu Moon
  • Jae Kil Park
  • Kyo Young Lee
  • Min Namkoong
  • Seha Ahn
Original Scientific Report



In clinical T1N0 peripheral lung cancers, lymph node upstaging is occasionally encountered postoperatively. However, nodal upstaging is rare in lung cancers presenting as ground-glass opacities. The aim of this study was to determine if lymph node upstaging could be reliably extrapolated from parameters such the consolidation/tumor ratio of chest computed tomography.


We conducted a retrospective study of 486 patients treated for peripheral clinical T1N0 non-small cell lung cancer, each undergoing lobectomy with mediastinal lymph node dissection. We compared preoperative variables in the pathologic N0 and nodal upstaging groups, analyzing such variables to determine factors predictive of lymph node upstaging.


Of the 486 patients studied, lymph node upstaging occurred in 42 (8.6%). In the upstaging group, the mean nodule diameter exceeded that of the pathologic N0 group (2.3 vs 1.9 cm, respectively; p < 0.001), and the mean consolidation/tumor ratio was larger in the upstaging group than the pN0 group (0.95 vs 0.68, respectively; p < 0.001). Nodule diameter and consolidation/tumor ratio emerged as significant predictive factors for lymph node upstaging after surgery in a multivariate analysis (hazard ratio [HR] 2.259, p = 0.039; HR 173.645, p = 0.001, respectively).


Consolidation/tumor ratio and nodule diameter are significant predictive factors of postoperative lymph node upstaging. The higher the consolidation/tumor ratio and smaller the nodule diameter, the less likely the occurrence of postoperative lymph upstaging would be in clinical T1N0 peripheral non-small cell lung cancer.



This research was not supported by outside funds.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.


  1. 1.
    Torre LA, Siegel RL, Jemal A (2016) Lung Cancer Statistics. Adv Exp Med Biol 893:1–19CrossRefPubMedGoogle Scholar
  2. 2.
    Aberle DR, Adams AM, Berg CD et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409CrossRefPubMedGoogle Scholar
  3. 3.
    Travis WD, Brambilla E, Noguchi M et al (2011) International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Wilshire CL, Louie BE, Manning KA et al (2015) Radiologic evaluation of small lepidic adenocarcinomas to guide decision making in surgical resection. Ann Thorac Surg 100:979–988CrossRefPubMedGoogle Scholar
  5. 5.
    Travis WD, Brambilla E, Nicholson AG et al (2015) The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 10:1243–1260CrossRefPubMedGoogle Scholar
  6. 6.
    Eguchi T, Kadota K, Park BJ et al (2014) The new IASLC-ATS-ERS lung adenocarcinoma classification: what the surgeon should know. Semin Thorac Cardiovasc Surg 26:210–222CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hattori A, Matsunaga T, Takamochi K et al (2017) Importance of ground glass opacity component in clinical stage IA radiologic invasive lung cancer. Ann Thorac Surg 104:313–320CrossRefPubMedGoogle Scholar
  8. 8.
    Nishio W, Yoshimura M, Maniwa Y et al (2016) Re-assessment of intentional extended segmentectomy for clinical T1aN0 non-small cell lung cancer. Ann Thorac Surg 102:1702–1710CrossRefPubMedGoogle Scholar
  9. 9.
    De Leyn P, Dooms C, Kuzdzal J et al (2014) Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 45:787–798CrossRefPubMedGoogle Scholar
  10. 10.
    Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246:697–722CrossRefPubMedGoogle Scholar
  11. 11.
    Lu P, Sun Y, Sun Y et al (2014) The role of (18)F-FDG PET/CT for evaluation of metastatic mediastinal lymph nodes in patients with lung squamous-cell carcinoma or adenocarcinoma. Lung Cancer 85:53–58CrossRefPubMedGoogle Scholar
  12. 12.
    Moon Y, Kim KS, Lee KY et al (2016) Clinicopathologic factors associated with occult lymph node metastasis in patients with clinically diagnosed N0 Lung adenocarcinoma. Ann Thorac Surg 101:1928–1935CrossRefPubMedGoogle Scholar
  13. 13.
    Edge SB, Byrd DR, Compton CC (2010) AJCC cancer staging manual. Springer, New YorkGoogle Scholar
  14. 14.
    Yoshiya T, Mimae T, Tsutani Y et al (2016) Prognostic role of subtype classification in small-sized pathologic N0 invasive lung adenocarcinoma. Ann Thorac Surg 102:1668–1673CrossRefPubMedGoogle Scholar
  15. 15.
    Moon Y, Sung SW, Lee KY et al (2016) The importance of the lepidic component as a prognostic factor in stage I pulmonary adenocarcinoma. World J Surg Oncol 14:37CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Heineman DJ, Ten Berge MG, Daniels JM et al (2016) Clinical staging of stage I non-small cell lung cancer in the Netherlands-need for improvement in an era with expanding nonsurgical treatment options: data from the Dutch lung surgery audit. Ann Thorac Surg 102:1615–1621CrossRefPubMedGoogle Scholar
  17. 17.
    Moon Y, Sung SW, Namkoong M et al (2016) The effectiveness of mediastinal lymph node evaluation in a patient with ground glass opacity tumor. J Thorac Dis 8:2617–2625CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Travis WD, Asamura H, Bankier AA et al (2016) The IASLC Lung Cancer Staging Project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol 11:1204–1223CrossRefPubMedGoogle Scholar
  19. 19.
    Kirmani BH, Rintoul RC, Win T et al (2013) Stage migration: results of lymph node dissection in the era of modern imaging and invasive staging for lung cancer. Eur J Cardiothorac Surg 43:104–109 (discussion 109–110) CrossRefPubMedGoogle Scholar
  20. 20.
    Samson P, Crabtree T, Broderick S et al (2017) Quality measures in clinical stage I non-small cell lung cancer: improved performance is associated with improved survival. Ann Thorac Surg 103:303–311CrossRefPubMedGoogle Scholar
  21. 21.
    Ye B, Cheng M, Li W et al (2014) Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg 98:217–223CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Youngkyu Moon
    • 1
  • Jae Kil Park
    • 1
  • Kyo Young Lee
    • 2
  • Min Namkoong
    • 1
  • Seha Ahn
    • 1
  1. 1.Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
  2. 2.Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

Personalised recommendations