title: Screening-detected lung cancers: is systematic nodal dissection always essential?
abstract: BACKGROUND
  To address whether systematic lymph node dissection is always necessary in early lung cancer, we identified factors predicting nodal involvement in a screening series and applied them to nonscreening-detected cancers.
  
  
  METHODS
  In the 97 patients with clinical T1-2N0M0 lung cancer (<3 cm), enrolled in the Continuous Observation of Smoking Subjects computed tomography (CT) screening study, who underwent curative resection with radical mediastinal lymph node dissection, we examined factors associated with hilar extrapulmonary and mediastinal nodal involvement. Nodule size plus positive/negative positron emission tomography (PET)-CT (usually as maximum standard uptake value [maxSUV]) were subsequently evaluated retrospectively for their ability to predict nodal involvement in 193 consecutive patients with nonscreening-detected clinical stage I lung cancer.
  
  
  RESULTS
  Among Continuous Observation of Smoking Subjects patients, 91 (94%) were pN0, and six (6.2%) were pN+. All patients with maxSUV <2.0 (p = 0.08) or pathological nodule ≤10 mm (p = 0.027) were pN0 (62 cases). Nodal metastases occurred in 6 cases among the 29 (17%) patients with lung nodule >10 mm and maxSUV ≥2.0 (p = 0.002 versus the other 62 cases). In the nonscreening series, 42 of 43 cases with negative PET-CT (usually maxSUV <2.0) or nodule ≤10 mm were pN0; 33 of 149 (22%) cases with positive PET-CT (usually maxSUV ≥ 2.0) and nodule >10 mm were pN+ (p = 0.001 versus the 43 cases).
  
  
  CONCLUSIONS
  This limited experience suggests that in early-stage clinically N0 lung cancers with maxSUV <2.0 or pathological nodule size ≤10 mm, systematic nodal dissection can be avoided as the risk of nodal involvement is very low.
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pelosi
authors.forename: Monica
authors.initials: M
authors.lastname: Casiraghi
authors.forename: Bernardo G
authors.initials: BG
authors.lastname: Agoglia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Borri
authors.forename: Laura L
authors.initials: LL
authors.lastname: Travaini
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rampinelli
authors.forename: Daniela
authors.initials: D
authors.lastname: Brambilla
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bertolotti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery; D016022:Case-Control Studies; D055088:Early Detection of Cancer; D005260:Female; D005462:Fluorine Radioisotopes; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis* / Q000601:surgery; D012907:Smoking; D014057:Tomography, X-Ray Computed
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals