Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software
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 all...
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doaj-5a32efabe917454d8a5c727c8ab381862020-11-25T00:31:49ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642019-09-0189310.4081/monaldi.2019.1068Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. softwareThomas Galasso0Lorenzo Corbetta1Laura Mancino2Lucio Michieletto3Loris Ceron4Pulmonology Unit, Santa Croce Hospital, FanoUnit of Diagnostic and Interventional Pulmonology, Careggi University Hospital, FlorencePulmonology Unit, dell’Angelo Hospital, MestrePulmonology Unit, dell’Angelo Hospital, MestrePulmonology Unit Ospedale dell’Angelo, Mestre-Venice 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. https://www.monaldi-archives.org/index.php/macd/article/view/1068pre-test probabilitypost-test probabilityBayes’ theoremmediastinal staging |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Thomas Galasso Lorenzo Corbetta Laura Mancino Lucio Michieletto Loris Ceron |
spellingShingle |
Thomas Galasso Lorenzo Corbetta Laura Mancino Lucio Michieletto Loris Ceron Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software Monaldi Archives for Chest Disease pre-test probability post-test probability Bayes’ theorem mediastinal staging |
author_facet |
Thomas Galasso Lorenzo Corbetta Laura Mancino Lucio Michieletto Loris Ceron |
author_sort |
Thomas Galasso |
title |
Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software |
title_short |
Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software |
title_full |
Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software |
title_fullStr |
Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software |
title_full_unstemmed |
Statistical approach to mediastinal staging in NSCLC with M.E.S.S.i.a. software |
title_sort |
statistical approach to mediastinal staging in nsclc with m.e.s.s.i.a. software |
publisher |
PAGEPress Publications |
series |
Monaldi Archives for Chest Disease |
issn |
1122-0643 2532-5264 |
publishDate |
2019-09-01 |
description |
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.
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topic |
pre-test probability post-test probability Bayes’ theorem mediastinal staging |
url |
https://www.monaldi-archives.org/index.php/macd/article/view/1068 |
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