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Staging Accuracy in Patients with Multiple Primary Lung Cancers
Benjamin Gallant, Erin Harris, Nathan Smith, Thomas Fabian.
Albany Medical Center, Albany, NY, USA.

OBJECTIVE: Multiple primary lung cancers (MPLC) can be defined as Synchronous (SMPLC) occurring at the same time or Metachronous (MMPLC) occurring at different time. The occurrence of MPLC is reported to range from 0.2% to 8.0%. These patients generally benefit from surgical resection and data shows 5 years survivorship to exceed 50%. We sought to evaluate the accuracy of preoperative staging assessments in patients with pathologically confirmed SMPLC utilizing a retrospective database.
METHODS: A retrospective database of surgical resected lung cancer patients between January 2019 and September 2019 was reviewed. Patients with non-malignant tumors, metastasis to the lungs, and MMPLC were excluded from evaluation. Preoperative clinical staging of referring physicians, CT scans, PET/CT scans, thoracic surgeons, and postoperative surgical histopathology were compared to assess for accuracy and inaccuracy. SMPLC were defined using modified Martini criteria. Data was recorded as under-staged/inadequate, accurately-staged, or over-staged.
RESULTS: Seventeen patients met the criteria during the study period. CT chest and PET scan were accurate in 18% of patients and under-staged in 76% and 59% of patients, respectively. Surgeon preoperative staging and pathology were accurate in 82% and 76% of patients. Surgeon preoperative staging was under-staged in 12% of patients, whereas referring physicians under-staged 35% of patients.
CONCLUSIONS: MPLC are common, however there is a significant risk of inaccurate staging based on our review. Surgeon preoperative staging is most accurate at 82%, when compared to the accuracy of CT scan and PET scan, which are less than 20%.


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