Is our preoperative TNM staging reliable

Introduction: Agreement between preoperative and surgical TNM staging is usually Aim: To compare our preoperative staging (cTNM) with surgical-pathological staging (pTNM). Methods: Cross-sectional study of patients with lung cancer surgically treated from 1-1-08 to 31-12-09, excluding relapses or neoadjuvant therapies. Preoperative staging based on: CT scan, positron emission tomography (PET-CT), endobronchial ultrasonography (EBUS), endoscopic ultrasonography (EUS), mediastinoscopy. Agreement between cTNM and pTNM (according to 1997 TNM classification) was analyzed. Results: 166 cases (characteristics in table 1). In table 2, concordance between cTNM and pTNM. cTNM and pTNM matched in 80 cases (48,2%), understaging occurred in 5 cases (3%) and overstaging in 81 (48,8%). But in most cases, this lack of agreement would not suppose changes in the therapeutic decision, just in 21 cases (12,5%) the cTNM carried out a wrong therapeutic procedure (18 N2 found in thoracotomy and 3 T4 unresectables). TC and PET-TC used in all cases, EBUS in 35, EUS in 2 and mediastinoscopy in 3. In N staging, PET-CT was cN0 in 133 cases (where 7 were pN2, 5,2%) and cN1 21 (8 pN2, 25,8%). We performed 35 EBUS (33 cN0, 2 cN1) and final pN was N2 in 3 cases (FN rate 8,5%). Conclusions: 1. Low agreement between cTNM and pTNM (48,2%), but only in 12,5% of cases would suppose a change in the treatment. 2. 25% of pN2 when cN1 by PET-CT (EBUS should be done). 3. When EBUS negative for N2, only 8,5% pN2.