title: Quality study of a lung cancer committee: study of agreement between preoperative and pathological staging.
abstract: 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 surgical-pathological 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 (CI) 0.44-0.63). The highest kappa value (0.68, 95% CI 0.53-0.82) was obtained in stage IA patients. Patients who underwent PET or PET-CT had a better kappa index (0.56, 95% CI 0.45-0.67, vs 0.39, 95% CI 0.21-0.56). Surgical-pathological staging validated surgery in 145 cases (82%), while 21 (12%) were revised to stage IIIA 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 IV and IA.
authors.affiliation: Department of Thoracic Surgery, Lung Functional Unit, Hospital Universitari de Bellvitge and Hospital Duran i Reynals-Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain. ivanmacia@yahoo.com
authors.forename: Ivan
authors.initials: I
authors.lastname: Macia
authors.forename: Juan
authors.initials: J
authors.lastname: Moya
authors.forename: Ignacio
authors.initials: I
authors.lastname: Escobar
authors.forename: Ricard
authors.initials: R
authors.lastname: Ramos
authors.forename: Cristina
authors.initials: C
authors.lastname: Masuet
authors.forename: Cristina
authors.initials: C
authors.lastname: Gamez
authors.forename: Roger
authors.initials: R
authors.lastname: Llatjos
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martinez-Ballarin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed