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Clinical Non-Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals

Wu, Dolly Y. and de Hoyos, Alberto and Vo, Dat T. and Hwang, Helena and Spangler, Ann E. and Seiler, Stephen J. (2021) Clinical Non-Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals. Academic Radiology, 28 (6). pp. 753-766. ISSN 1076-6332. doi:10.1016/j.acra.2020.04.007.

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Rationale and Objectives: Examine the accuracy of clinical non–small cell lung cancer staging and tumor length measurements, which are critical to prognosis and treatment planning. Materials and Methods: Compare clinical and pathological staging and lengths using 10,320 2016 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) and 559 2010–2018 non-SEER single-institute surgically-treated cases, and analyze modifiable causes of disagreement. Results: The SEER clinical and pathological group-stages agree only 62.3% ± 0.9% over all stage categories. The lymph node N-stage agrees much better at 83.0% ± 1.0%, but the tumor length-location T-stage agrees only 57.7% ± 0.8% with approximately 29% of the cases having a greater pathology than clinical T-stage. Individual T-stage category agreements with respect to the number of pathology cases are Tis, T1a, T1b, T2a, T2b, T3, T4: 89.9% ± 10.0%; 78.7% ± 1.7%; 51.8% ± 1.9%; 46.1% ± 1.3%; 40.5% ± 3.1%; 44.1% ± 2.2%; 56.4% ± 4.7%, respectively. Most of the single-institute results statistically agree with SEER's. Excluding Tis cases, the mean difference in SEER tumor length is ∼1.18 ± 9.26 mm (confidence interval: 0.97–1.39 mm) with pathological lengths being longer than clinical lengths except for small tumors; the two measurements correlate well (Pearson-r >0.87, confidence interval: 0.86–0.87). Reasons for disagreement include the use of family-category descriptors (e.g., T1) instead of their subcategories (e.g., T1a and T1b), which worsens the T-stage agreement by over 15%. Disagreement is also associated with higher tumor grade, larger resected specimens, higher N-stage, patient age, and periodic biases in clinical and pathological tumor size measurements. Conclusions: By including preliminary non–small cell lung cancer clinical stage values in their evaluation, diagnostic radiologists can improve the accuracy of staging and standardize tumor-size measurements, which improves patient care.

Item Type:Article
Related URLs:
URLURL TypeDescription
Vo, Dat T.0000-0001-9088-7132
Spangler, Ann E.0000-0002-0982-1855
Additional Information:© 2020 Published by Elsevier Inc. on behalf of The Association of University Radiologists. This research did not receive any specific grant from funding agencies. The retrospective patient review study protocol was approved by the UTSW Institutional Review Board (STU042018-003, with waived informed consent).
Subject Keywords:Lung cancer staging; Clinical and pathological staging; Tumor length; Accuracy
Issue or Number:6
Record Number:CaltechAUTHORS:20200623-154343462
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Official Citation:Dolly Y. Wu, Alberto de Hoyos, Dat T. Vo, Helena Hwang, Ann E. Spangler, Stephen J. Seiler, Clinical Non–Small Cell Lung Cancer Staging and Tumor Length Measurement Results From U.S. Cancer Hospitals, Academic Radiology, Volume 28, Issue 6, 2021, Pages 753-766, ISSN 1076-6332, (
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:103975
Deposited By: Tony Diaz
Deposited On:23 Jun 2020 23:01
Last Modified:26 May 2021 18:52

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