What is it about?

Central location is an indication for invasive mediastinal staging of lung cancer. However, there is no clear/specific definition of central tumors and guidelines are inconsistent. In our study we utilized an imaging software that can divide the lung in equal thirds following different patterns, allowing us to test different definitions of central tumors. We proved that the hemithorax should be divided with concentric lines, but we failed to find differences between utilizing the inner one third or the inner two thirds to define centrality. We also found that regardless the location (central/peripheral) of T1N0M0 tumors, the prevalence of N2/N3 disease is relatively low, and hence this distinction (central/peripheral) may not be that useful for patients who will undergo surgery. On the other hand, we found that tumors are significantly likely to be upstaged to any N (including now N1 as well) if they are centrally located.

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Why is it important?

Our study give us a more clear and objective definition of centrally located tumors. But maybe more importantly, we found that while the probability of being upstaged to pN2/3 disease in central T1N0M0 is low, the probability of being upstaged to pN1-2-3 is truly significant. Hence, invasive nodal staging is key in patients with centrally located tumors who are candidates for non-surgical local ablative therapies.


I hope this article helps inform future guidelines on staging of lung cancer. When we make decisions that lead to invasive procedures on our patients, we want, as much as possible, to base these decisions on scientific evidence.

Roberto Casal
The University of Texas MD Anderson Cancer Center

Read the Original

This page is a summary of: Centrally located lung cancer and risk of occult nodal disease: an objective evaluation of multiple definitions of tumour centrality with dedicated imaging software, European Respiratory Journal, February 2019, European Respiratory Society (ERS), DOI: 10.1183/13993003.02220-2018.
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