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A pragmatic approach to the diagnosis of nodal micrometastases in early stage non-small cell lung cancer

Introduction - This study was designed to develop a both sensitive and efficient algorithm for detection of lymph node micrometastases and to determine its prognostic impact in patients with early stage non-small cell lung cancer (NSCLC). - Methods - One hundred seventy patients with NSCLC p stage I...

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Main Authors: Herpel, Esther (Author) , Muley, Thomas (Author) , Schneider, Thomas (Author) , Palm, Elisa Maria (Author) , Kieslich de Hol, Dörthe (Author) , Warth, Arne (Author) , Meister, Michael (Author) , Storz, Konstantina (Author) , Schnabel, Philipp Albert (Author) , Schirmacher, Peter (Author) , Dienemann, Hendrik (Author) , Hoffmann, Hans (Author)
Format: Article (Journal)
Language:English
Published: [August 2010]
In: Journal of thoracic oncology
Year: 2010, Volume: 5, Issue: 8, Pages: 1206-1212
ISSN:1556-1380
DOI:10.1097/JTO.0b013e3181e15cfd
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/JTO.0b013e3181e15cfd
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1556086415305803
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Author Notes:Esther Herpel, Thomas Muley, Thomas Schneider, Elisa Palm, Dörthe Kieslich de Hol, Arne Warth, Michael Meister, Konstantina Storz, Philipp A. Schnabel, Peter Schirmacher, Hendrik Dienemann, and Hans Hoffmann
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Summary:Introduction - This study was designed to develop a both sensitive and efficient algorithm for detection of lymph node micrometastases and to determine its prognostic impact in patients with early stage non-small cell lung cancer (NSCLC). - Methods - One hundred seventy patients with NSCLC p stage I and II were included in this study, of which n = 5299 lymph nodes were obtained and submitted to histopathologic analysis. From each patient, a median number of 31 lymph nodes was received (N-1 position: median n = 16; N-2 position: median n = 15). Immunohistochemistry was performed to detect micrometastases unobvious by conventional microscopy using antibodies against cytokeratins (CK) (pan-CK: KL-1, CK 5/6, CK 7) and the epithelial marker Ber-EP4. - Results - In 82 patients (48.2%), micrometastases were revealed in immunohistochemistry staining. KL-1 detected micrometastases in 201 (99.5%) of 202 positive lymph nodes. Subsequently, this resulted in an upstaging in 39 patients (20.5%). Detection of micrometastases in otherwise tumor-free N2-lymph nodes had a significant prognostic impact (mean disease-free survival 21.4 versus 45.3 months, p = 0.022), affecting 4.7% of patients. Survival differences between patients who were upstaged into stage II (N0>N1) and those remaining in stage I were not statistically significant (p = 0.537). - Conclusion - Extended workup of N2-lymph nodes using one broad-spectrum keratin marker in otherwise N2-negative lymph nodes may represent a both efficient and sensitive approach to the identification of micrometastases in dissected lymph nodes of patients with early stage NSCLC.
Item Description:Elektronische Reproduktion der Druckausgabe
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Physical Description:Online Resource
ISSN:1556-1380
DOI:10.1097/JTO.0b013e3181e15cfd

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