Wedge Resection and Staging Lymphadenectomy Can Downstage Primary Pulmonary Adenocarcinomas
Ann E Walts, Alberto M Marchevsky. Cedars-Sinai Medical Center, Los Angeles, CA
Background: There is increasing interest in treating clinical Stage I primary pulmonary adenocarcinoma (AC) with wedge resection and staging lymphadenectomy (SLN). Studies have evaluated survival and recurrence rates following these procedures but there is no information about the possible effect of this approach on pathologic staging of AC patients.
Design: 241 consecutive AC wedge resections followed by immediate lobectomy or trisegmentectomy and SLN between 2008 and 2012 were retrieved from our pathology database. Demographics, tumor location, size, pT (AJCC 7th ed.) and distance from tumor to closest margin (D) were recorded in the wedge specimens and compared with the presence of residual and/or additional tumor in the lung parenchyma of the 2nd specimens and with pN in the peribronchial lymph nodes (PBLN) and in the SLN.
Results: The 241 wedges (99 RUL, 13 RML, 41 RLL, 57 LUL, 31 LLL) were from 130 females and 111 males (median age 71 yrs). Tumors in the wedges were 0.6 to 7.2 cm (median 1.8 cm) in diameter and included 116 pT1a, 38 pT1b, 78 pT2a, and 9 pT3 lesions. D ranged from 0.1 to 5.0 cm (median 0.5 cm). The 2nd specimens consisted of 225 lobectomies, 13 trisegmentectomies, and 3 bilobectomies with 0 to 13 PBLN per case (median 2 per case). SLN consisted of 0 to 30 nodes per case (median 7 per case). Residual AC (n=14), additional AC nodules (n=9), and both (n=1) were found in the 2nd specimen lung parenchyma in 24 (10.0%) cases. Problems orienting residual tumor to tumor in the wedge made it difficult to accurately determine total tumor size and final pT in these cases. D was <1 cm in 13 of the 15 cases with residual tumor in the 2nd specimen. The 10 cases with additional AC nodules would have been downstaged as pT1 rather than pT3 by wedge resection. Metastatic AC was found in the nodes in 44 (18.3%) cases including PBLN (n=10), SLN (n=20), both (n=14). The 10 (4.1%) cases with positive PBLN would have been downstaged as pN0 rather than pN1 by wedge resection with SLN.
Conclusions: Wedge resections with SLN would have downstaged 7.9% of our cases (9 as pT1 rather than pT3, 9 as pN0 rather than pN1, and 1 as both). Wedge resection margins >1 cm were associated with residual tumor in <1% of our cases. Future studies are needed to determine whether correlation with imaging would improve pathologic staging accuracy in AC patients undergoing lung-sparing procedures.
Monday, March 4, 2013 1:00 PM
Poster Session II # 295, Monday Afternoon