Comparison Between Clinical And Surgical-Pathological TNM Staging In 100 Cases With Lung Cancer

Objective:The aim of this study is to evaluate the concordance between clinical and surgical-pathological staging in 100 patients with lung cancer and analyze its cause in detail.Methods:100 patients with lung cancer treated surgically from June,2007 to March,2008 were enrolled randomly.All cases underwent chest X-Ray,chest CT and abdominal ultrasound examinations preoperatively,in which 93 cases underwent ECT bone scan and 17 cases underwent PET-CT examination at the same time.Clinical TNM staging was made according to the International System for Staging Lung Cancer revised by UICC in 1997(According to the 1997 revision of the TNM staging system for lung cancer,CT was the main diagnostic method,neither PET nor mediastinoscopy was included yet.As an important technique for staging,PET-CT was also involved in clinical TNM staging in this study).All cases underwent surgery in 3 weeks and then surgical-pathological TNM staging was made according to the findings during the surgery and the postoperative pathological results.Then concordance was determined between the two staging results with Kappa value.(Kappa value≥0.75 means perfect agreement,0.75＞Kappa value≥0.4 means moderate agreement,Kappa value＜ 0.4 means poor agreement).Statistical analyses were performed using SPSS 11.5 (SPSS Inc.,Chicago,Ill.,USA)software and the coincident rates between every two T substagings were analyzed by the x~2 test.We considered results significant when P＜0.05.Results:The coincident rate of T staging was 79.0%,and the agreement was substantial(Kappa value=0.654,P=0.000).The coincident rates between every two T substagings had no significant deviation(P＞0.1).The coincident rate of N staging was 65.7%,and the agreement was moderate(Kappa value=0.459,P=0.000).The coincident rate of TNM staging was 54.8%,and the agreement was fair(Kappa value=0.407,P=0.000).Conclusions:1.Clinical T staging based on CT can indicate the location,size and borderline of primary tumor precisely.2.The conformity of N staging is poor,which indicates that the size of lymph node based on CT scan is not a reliable index to decide metastasis.3.The agreement of TNM staging based on CT scan(Kappa value=0.407)is fair but close to the minimum standard(Kappa value=0.4).The agreement of T staging is better than that of N staging.Seeking more credible preoperative diagnostic techniques to improve the staging accuracy,especially for N staging,is still an urgently topic.