Predicting pathological lymph node status in clinical stage IA peripheral lung adenocarcinoma

Eur J Cardiothorac Surg. 2021 Jul 14;60(1):64-71. doi: 10.1093/ejcts/ezaa478.


Objectives: Even with current diagnostic technology, it is difficult to accurately predict pathological lymph node status (PLNS). This study aimed to develop a prediction model of PLNS in peripheral adenocarcinoma with a dominant solid component, based on clinical and radiological factors on thin-section computed tomography, to identify patients to whom wedge resection or other local therapies could be applied.

Methods: Of 811 patients enrolled in a prospective multi-institutional study (JCOG0201), 420 patients with clinical stage IA peripheral lung adenocarcinoma having a dominant solid component were included. Multivariable logistic regression was performed to develop a model based on clinical and centrally reviewed radiological factors. Leave-one-out cross-validation and external validation analyses were performed, using independent data from 221 patients. Sensitivity, specificity and concordance statistics were calculated to evaluate diagnostic performance.

Results: The formula for calculating the probability of pathological lymph node metastasis included the following variables: tumour diameter (including ground-glass opacity), consolidation-to-tumour ratio and density of solid component. The concordance statistic was 0.8041. When the cut-off value associated with the risk of incorrectly predicting negative pathological lymph node metastasis (pN-) was 4.9%, diagnostic sensitivity and specificity in predicting PLNS were 95.7% and 46.0%, respectively. The concordance statistic for the external validation set was 0.7972, and diagnostic sensitivity and specificity in predicting PLNS were 95.4% and 40.5%, respectively.

Conclusions: The proposed model is clinically useful and successfully predicts pN- in patients with clinical stage IA peripheral lung adenocarcinoma with a dominant solid component.

Keywords: Lung adenocarcinoma; Lung cancer; Lymph node metastasis; Non-small-cell lung cancer; Prediction model.

Publication types

  • Multicenter Study

MeSH terms

  • Adenocarcinoma of Lung* / diagnostic imaging
  • Adenocarcinoma of Lung* / pathology
  • Humans
  • Lung Neoplasms* / diagnostic imaging
  • Lung Neoplasms* / pathology
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Neoplasm Staging
  • Prognosis
  • Prospective Studies
  • Retrospective Studies