Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software

https://doi.org/10.4081/monaldi.2019.1068

Authors

  • Thomas Galasso Pulmonology Unit, Santa Croce Hospital, Fano, Italy.
  • Lorenzo Corbetta Unit of Diagnostic and Interventional Pulmonology, Careggi University Hospital, Florence, Italy.
  • Laura Mancino Pulmonology Unit, dell’Angelo Hospital, Venice-Mestre, Italy.
  • Lucio Michieletto Pulmonology Unit, dell’Angelo Hospital, Venice-Mestre, Italy.
  • Loris Ceron | lorceron@gmail.com Pulmonology Unit, dell’Angelo Hospital, Venice-Mestre, Italy.

Abstract

The exclusion of pathological involvement of mediastinal lymph nodes in patients affected by NSCLC plays a central role in assessing  their prognosis and operability. Ceron et al. developed a software - called M.E.S.S.i.a (Mediastinal Evaluation with Statistical Support; instant approach) - that allows the calculation of the residual probability of lymph node involvement after a certain number of tests has been done, by integrating every test result with the pre-test prevalence. M.E.S.S.i.a. bridges a gap of current American College of Chest Physicians (ACCP) guidelines, providing probability values of mediastinal metastasis for a correct clinical decision. We conducted a preliminary retrospective study in a series of 108 patients affected by non small cell lung cancer (NSCLC). Pathological staging was compared to the probability of nodal involvement calculated by M.E.S.S.i.a. software. Forty-two out of 108 subjects (39%) had a calculated post-test probability <8%; none of these had proven N2/N3 metastasis at surgical staging (negative predictive value, NPV: 100%). In 12/41 cases M.E.S.S.i.a. was able to avoid invasive procedures. The remaining 66 (61%) patients did not reach the surgical threshold; among these, 11 displayed N2 positivity at pathological staging. Receiving operator curve (ROC) analysis produced an area under curve (AUC) value of  0.773 (p<0.001). These preliminary data show high accuracy of M.E.S.S.i.a. software in excluding N2/N3 lymph node involvement in NSCLC. We have therefore promoted a prospective multicenter study in order to to get a validation of the calculator at different levels of probability of lymph node involvement. The recruitable subjects are potentially operable NSCLC patients; the gold standard for detection of mediastinal disease is the surgical lymph node dissection.

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Published
2019-09-10
Info
Issue
Section
Pneumology - Original Articles
Keywords:
pre-test probability, post-test probability, Bayes’ theorem, mediastinal staging
Statistics
  • Abstract views: 628

  • PDF: 403
How to Cite
Galasso, Thomas, Lorenzo Corbetta, Laura Mancino, Lucio Michieletto, and Loris Ceron. 2019. “Statistical Approach to Mediastinal Staging in NSCLC With M.E.S.S.i.a. Software”. Monaldi Archives for Chest Disease 89 (3). https://doi.org/10.4081/monaldi.2019.1068.

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