The accuracy of clinical staging of stage I-IIIA non-small cell lung cancer by using thoracic computed tomography

Abstract

Purpose: To assess the accuracy of clinical staging of stage I-IIIA non-small cell lung cancer (NSCLC) by using thoracic computed tomography (CT). Patients and Methods: Medical records of patients with NSCLC operated in two years 2018-2019 at Surgery Department No 2, HCMC Oncology Hospital were studied retrospectively. Results: Thoracic CT diagnosed tumor stage with an accuracy of 79% but failed to detect T3-4 disease in 8% of cases. Of nodal disease, thoracic CT had a diagnostic accuracy of 58% but misclassified N2 disease in 18% of cases. Agreement was poor between clinical and pathologic stage (Kappa coefficient= 0.186). Only 48% of patients was diagnosed accurately, and clinically understaged patients (45%) were more frequent than clinically overstaged one. Thoracic CT had a low sensitivity of only 19% in detecting stage IIIA disease, with 13 stage IIIA patients (21%) were missed diagnosis. Conclusion: Thoracic CT is not an ideal means for clinical staging of stage I-IIIA non-small cell lung cancer. To prevent the worsened outcomes associated with inaccurate staging, physicians should rely on established staging guidelines. Key words: non-small cell lung cancer, clinical staging, thoracic computed tomography