Objective:Accurate preoperative staging is essential to provide the best treatment for lung cancer. The objective of the present study was to determine agreement between preoperative and surgicalpathological staging and to analyse the impact of any disparity on treatment.Methods:This is a descriptive study of a series of 176 lung cancer cases treated by surgery between 2005 and 2007.Preoperative staging was based on clinical information and computed tomography (CT),positron emission tomography (PET),PET-CT,bronchoscopy and mediastinoscopy.In all cases,surgical-pathological staging was based on the analysis of surgical samples and the findings during surgery.Both preoperative and pathological stage determination were based on the TNM (tumour,node,metastasis) classification established in 1997.Concordance was measured by calculating agreement rates and the kappa value.Results:Preoperative and surgical-pathological staging agreed in 102 cases,an agreement rate of 58% and kappa value of 0.54 (95% confidence interval (Cl) 0.44-0.63). The highest kappa value (0.68,95% Cl 0.530.82) was obtained in stage IA patients.Patients who underwent PETor PET-CT had a better kappa index (0.56,95% Cl 0.45-0.67,vs 0.39,95% Cl 0.210.56).Surgical-pathological staging validated surgery in 145 cases (82%),while 21 (12%) were revised to stage 111A N2 and 10 (6%) to non-surgical stages.Conclusions:Global agreement between preoperative and surgical-pathological staging was moderate. The best agreement was found in stages 1V and IA.
Bronchogenic carcinoma Neoplasm staging Preoperative staging Surgical-pathological staging Surgery
Ivan Macia Juan Moya Ignacio Escobar Ricard Ramos Cristina Masuet Cristina Gamez Roger Llatjos Ignacio Martinez-Ballarin
Department of Thoracic Surgery,Lung Functional Unit,Hospital Universitari de Beilvitge and Hospital Department of Thoracic Surgery and School of Medicine of the University of Barcelona,LHospitalet de Department of Preventive Medicine and Biostatistics,Hospital Universitari de Beilvitge,LHospitalet PET-CT Unit,Institut de Diagnostic per la Imatge,Lung Functional Unit,Hospital Universitari de Beilv Department of Pathology,Lung Functional Unit,Hospital Universitari de Beilvitge and Hospital Durani Department of Pulmonology,Lung Functional Unit,Hospital Universitari de Beilvitge and Hospital Duran