A Prediction Model to Optimize Invasive Mediastinal Staging Procedures for Non-small Cell Lung Cancer in Patients With a Radiologically Normal Mediastinum: The Quebec Prediction Model.

Background: Current guideline-recommended criteria for invasive mediastinal staging in patients with a radiologically normal mediastinum fail to identify a significant proportion of patients with occult mediastinal disease (OMD), despite it leading to a large number of invasive staging procedures.

Research Question: Which variables available before surgery predict the probability of OMD in patients with a radiologically normal mediastinum?

Study Design And Methods: We identified all cTxN0/N1M0 non-small cell lung cancer tumors staged by CT imaging and PET with CT imaging in our institution between 2014 and 2018 who underwent gold standard surgical lymph node dissection or were demonstrated to have OMD before surgery by invasive mediastinal staging techniques and divided them into a derivation and an independent validation cohort to create the Quebec Prediction Model (QPM), which allows calculation of the probability of OMD.

Results: Eight hundred three patients were identified (development set, n = 502; validation set, n = 301) with a prevalence of OMD of 9.

Added value of invasive needle techniques in mediastinal and hilar nodal staging of clinical N0-N1 non-small cell lung cancer after positron emission tomography.

Previous studies evaluating staging methods of lung cancer have focused on mediastinal disease. We explored the added value of endoscopic techniques after PET scan in the evaluation of N1 nodal stations in 276 patients with a radiologically normal mediastinum demonstrating a potential stage shift in 20% of patients.