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I. Dinga-Madou

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    O20 - Staging and Advanced Disease (ID 102)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Surgery
    • Presentations: 1
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      O20.01 - Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) is Superior to PET/CT for Restaging of the Mediastinum after Neoadjuvant Therapy for Non-Small Cell Lung Cancer (NSCLC) (ID 358)

      16:15 - 17:45  |  Author(s): I. Dinga-Madou

      • Abstract
      • Presentation
      • Slides

      Accurate staging of the mediastinum is critical in therapeutic decision making in NSCLC. PET/CT has emerged as an important modality for staging of treatment-naïve NSCLC, but like endobronchial ultrasound and conventional mediastinoscopy typically is inaccurate following neoadjuvant therapy. We sought to determine the accuracy of TEMLA in staging NSCLC after induction therapy.

      A retrospective chart review looking at clinical stage assessed by PET -CT and TEMLA, pathologic stage, lymph node yield and clinical characteristics was performed. Accuracy of staging by TEMLA and PET-CT was compared.

      71 of 100 consecutive patients that underwent TEMLA had it for restaging after neoadjuvant therapy; 65 of these patients were also restaged by PET-CT. Clinical characteristics of these 65 patients are presented (Table 1). TEMLA was completed successfully on 63 (96.9%) patients and was associated with permanent recurrent laryngeal nerve injury in 2 (3%) patients. On average, 17 lymph nodes were obtained per TEMLA. Concomitant anatomic resections were completed in 58 (89.2%) of patients. 12 and 3 (18.5% and 4.6%) patients were classified as having N2 and N3 disease on final pathology. Compared to PET-CT, TEMLA more accurately classified these patients (95.4% vs. 80.0%; P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT and TEMLA for detection of N2 disease are 50.0%, 86.8%, 46.1%, 88.5% and 75%, 100%, 100%, 94.6% respectively (Table 2). Of the 3 patients inaccurately classified by TEMLA, only 1 patient had N2 disease in TEMLA-accessible nodes. Figure 1

      Table 2: Patient numbers according to nodal status.
      Path + Path - PET + PET -
      TEMLA + 9 0 4 5
      TEMLA - 3 53 9 47
      PET + 6 7
      PET - 6 46

      TEMLA is superior to PET/CT for restaging of the mediastinum after induction therapy. Since TEMLA showed little added morbidity despite central tumor and treatment effects, consideration should be given for its widespread adoption for mediastinal re-staging of NSCLC after neoadjuvant therapy.

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