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Post-Thoracotomy Diagnostic and Staging Conversion Rates of Clinically Staged I Lung Cancer

The accuracy of stage I lung cancer assessment achieved by traditional clinico-diagnostic staging was retrospectively evaluated in 164 consecutive patients who underwent thoracotomy. The diagnostic conversion rate was 6.7 % (1 carcinoid and 10 innocent pulmonary lesions) and occurred only in the subset of patients lacking preoperative pathologic confirmation (15 %). The conversion rate to unresectable tumor extent was 8 % (11/153), and local spread was the main cause of unresectability (5.5 %). The staging conversion rate was 29 % (43/153): the conversion rate for nodal evaluation was double that of primary tumor evaluation (24 % versus 12 %), but conversion to anatomically unresectable nodal diffusion occurred in only one patient (0.6 %). The ability of the surgeon to convert the wrong diagnosis was scanty without extemporary biopsy, and 7 patients with innocent lesions underwent standard resection for primary cancer. Surgical staging was as precise as pathological staging in primary tumor evaluation, but was faulty in nodal evaluation (15 % error in sN0 and sN1-2 assessment). It is concluded that following stage I lung cancer assessment by traditional means, supplementary examinations are requested for a better sensitivity of pathological confirmation and a better refinement of local spread. Better nodal evaluation has less value until a biologic limit to surgery for anatomically resectable nodal diffusion is universally accepted.