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Sublobar Resection in Stage IA Non-Small Cell Lung Cancer: Role of Preoperative CT Features in Predicting Pathologic Lymphovascular Invasion and Postoperative Recurrence.

Background: Prognostic factors on preoperative CT in stage IA non-small cell lung cancer (NSCLC) may help select patients to undergo sublobar resection or lobectomy. Objective: To identify CT features predictive of pathologic lymphovascular invasion (pLVI) in stage IA NSCLC and to evaluate the features' prognostic value in patients who undergo sublobar resection. Methods: This retrospective study included 904 patients (mean age 62 years; 453 men, 451 women) who underwent lobectomy (n=574) or sublobar resection (n=330) for stage IA NSCLC. Two thoracic radiologists independently evaluated findings on preoperative chest CT and then resolved discrepancies. Recurrences were identified from medical record review. Multivariable logistic regression was used to identify independent predictors of pLVI. Multivariable Cox proportional hazards models were used to identify prognostic features. Interreader agreement was assessed. Results: pLVI was present in 10.2% (92/904) of patients. pLVI was present only in solid-dominant part solid nodules (PSNs) and solid nodules, and only in nodules with solid portion diameter >10 mm. Among solid-dominant PSNs and solid nodules with solid portion diameter >10 mm, independent (p<.05) predictors of pLVI were peritumoral interstitial thickening [odds ratio (OR)=13.22] and pleural contact (defined as pleural contact measuring over one quarter of the circumference of the nodule's solid portion) (OR=2.45). Also among such nodules, peritumoral interstitial thickening achieved sensitivity 80.4%, specificity 76.7%, and accuracy 77.4%; pleural contact achieved sensitivity 35.9%, specificity 82.5%, and accuracy 74.3%; and presence of either feature achieved sensitivity 90.2%, specificity 64.3%, and accuracy 68.9%, for pLVI. In patients undergoing sublobar resection, after adjusting for T stage and operative type, recurrence-free survival (RFS) was independently (p<.05) predicted by solid-dominant PSN or solid nodule with solid portion diameter >10 mm, also demonstrating peritumoral interstitial thickening (HR=5.37) or peritumoral interstitial thickening or pleural contact (HR=6.05). Interreader agreement demonstrated kappa=0.67 for peritumoral interstitial thickening and kappa=0.77 for pleural contact. Conclusion: pLVI occurred only in solid-dominant PSNs and solid nodules with solid portion >10 mm. Among such nodules, peritumoral interstitial thickening and pleural contact independently predicted pLVI and RFS. Clinical Impact: CT features may help select patients with stage IA NSCLC for sublobar resection rather than more extensive surgery.