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

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; instan 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.

Authors+Show Affiliations

Pulmonology Unit, Santa Croce Hospital, Fano. thomas.galasso123@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31505918

Citation

Galasso, Thomas, et al. "Statistical Approach to Mediastinal Staging in NSCLC With M.E.S.S.i.a. Software." Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace, vol. 89, no. 3, 2019.
Galasso T, Corbetta L, Mancino L, et al. Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software. Monaldi Arch Chest Dis. 2019;89(3).
Galasso, T., Corbetta, L., Mancino, L., Michieletto, L., & Ceron, L. (2019). Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software. Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace, 89(3), doi:10.4081/monaldi.2019.1068.
Galasso T, et al. Statistical Approach to Mediastinal Staging in NSCLC With M.E.S.S.i.a. Software. Monaldi Arch Chest Dis. 2019 Sep 10;89(3) PubMed PMID: 31505918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software. AU - Galasso,Thomas, AU - Corbetta,Lorenzo, AU - Mancino,Laura, AU - Michieletto,Lucio, AU - Ceron,Loris, Y1 - 2019/09/10/ PY - 2019/03/24/received PY - 2019/07/24/accepted PY - 2019/9/12/entrez PY - 2019/9/12/pubmed PY - 2019/9/12/medline JF - Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace JO - Monaldi Arch Chest Dis VL - 89 IS - 3 N2 - 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; instan 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. SN - 1122-0643 UR - https://www.unboundmedicine.com/medline/citation/31505918/Statistical_approach_to_mediastinal_staging_in_NSCLC_with_M.E.S.S.i.a._software L2 - https://doi.org/10.4081/monaldi.2019.1068 DB - PRIME DP - Unbound Medicine ER -