Advances in Surgical Sciences
Volume 5, Issue 1, February 2017, Pages: 7-14
Received: Feb. 24, 2017;
Accepted: Mar. 28, 2017;
Published: Apr. 17, 2017
Views 1806 Downloads 123
Blane Gordon McMillan, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
Sanjeet Avtaar Singh, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland
Sudeep Das De, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland
Alan Kirk, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, Scotland
Tumours of the thymus gland have a limited evidence base due to their low incidence rate. The Masaoka-Koga staging system has been known as the strongest prognostic indicator for both survival and recurrence of thymic tumours but there is no standardised way to assess clinical staging in pre-operative images. As appropriate staging can influence patients’ need for adjuvant therapy, it is important to evaluate if current imaging can accurately predict post-operative staging. This was a retrospective study comparing the pre-operative radiological staging and post-operative pathological staging of 34 patients. This was conducted at the Golden Jubilee National Hospital between March 2013 and October 2016. A Kappa statistic was used to evaluate agreement between the assessments. 61.8% (21 out of 34) of the CT stages agreed with the pathology stages: 78.6% (11 out of 14) in stage I; 41.7% (5 out of 12) in stage II; 40% (2 out of 5) in stage III; and 100% (3 out of 3) in stage IV. There was moderate agreement between the preoperative CT assessment and the post-operative pathological staging (kappa coefficient = 0.42, p value < 0.01). With further analysis of a larger sample size it could be concluded that radiological staging of thymic tumours before surgery is quite accurate but requires standardisation and utilisation of other imaging techniques to ensure appropriate levels of care.
Blane Gordon McMillan,
Sanjeet Avtaar Singh,
Sudeep Das De,
Comparison of Radiology and Histopathology in Thymic Epithelial Tumours, Advances in Surgical Sciences.
Vol. 5, No. 1,
2017, pp. 7-14.
TRAVIS, W. World Health Organisation, (2004). Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: IARCPress.
ENGELS, E. A. 2010. Epidemiology of thymoma and associated malignancies. J Thorac Oncol, 5, S260-5.
VENUTA, F., ANILE, M., DISO, D., VITOLO, D., RENDINA, E. A., DE GIACOMO, T., FRANCIONI, F. & COLONI, G. F. 2010. Thymoma and thymic carcinoma. Eur J Cardiothorac Surg, 37, 13-25.
BARNES, E. W. & IRVINE, W. J. 1973. Clinical syndromes associated with thymic disorders. Proc R Soc Med, 66, 151-4.
KOGA, K., MATSUNO, Y., NOGUCHI, M., MUKAI, K., ASAMURA, H., GOYA, T. & SHIMOSATO, Y. 1994. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int, 44, 359-67.
MASAOKA, A., MONDEN, Y., NAKAHARA, K. & TANIOKA, T. 1981. Follow-up study of thymomas with special reference to their clinical stages. Cancer, 48, 2485-92.
REGNARD, J. F., MAGDELEINAT, P., DROMER, C., DULMET, E., DE MONTPREVILLE, V., LEVI, J. F. & LEVASSEUR, P. 1996. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg, 112, 376-84.
ATTARAN, S., MCCORMACK, D., PILLING, J. & HARRISON-PHIPPS, K. 2012. Which stages of thymoma benefit from adjuvant chemotherapy post-thymectomy? Interact Cardiovasc Thorac Surg, 15, 273-5.
VENUTA, F., RENDINA, E. A., PESCARMONA, E. O., DE GIACOMO, T., VEGNA, M. L., FAZI, P., FLAISHMAN, I., GUARINO, E. & RICCI, C. 1997. Multimodality treatment of thymoma: a prospective study. Ann Thorac Surg, 64, 1585-91; discussion 1591-2.
RIEKER, R. J., HOEGEL, J., MORRESI-HAUF, A., HOFMANN, W. J., BLAEKER, H., PENZEL, R. & OTTO, H. F. 2002. Histologic classification of thymic epithelial tumors: comparison of established classification schemes. Int J Cancer, 98, 900-6.
DETTERBECK, F. C., NICHOLSON, A. G., KONDO, K., VAN SCHIL, P. & MORAN, C. 2011. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol, 6, S1710-6.
LANDIS, J. R. & KOCH, G. G. 1977. The measurement of observer agreement for categorical data. Biometrics, 33, 159-74.
HUANG, J., DETTERBECK, F. C., WANG, Z. & LOEHRER, P. J., SR. 2011. Standard outcome measures for thymic malignancies. J Thorac Oncol, 6, S1691-7.
FALKSON, C. B., BEZJAK, A., DARLING, G., GREGG, R., MALTHANER, R., MAZIAK, D. E., YU, E., SMITH, C. A., MCNAIR, S., UNG, Y. C., EVANS, W. K. & LUNG CANCER DISEASE SITE GROUP OF CANCER CARE ONTARIO'S PROGRAM IN EVIDENCE-BASED, C. 2009. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol, 4, 911-9.
MAROM, E. M. 2013. Advances in thymoma imaging. J Thorac Imaging, 28, 69-80; quiz 81-3.
DE KRAKER, M., KLUIN, J., RENKEN, N., MAAT, A. P. & BOGERS, A. J. 2005. CT and myasthenia gravis: correlation between mediastinal imaging and histopathological findings. Interact Cardiovasc Thorac Surg, 4, 267-71.
JEONG, Y. J., LEE, K. S., KIM, J., SHIM, Y. M., HAN, J. & KWON, O. J. 2004. Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis? AJR Am J Roentgenol, 183, 283-9.
MAROM, E. M., MILITO, M. A., MORAN, C. A., LIU, P., CORREA, A. M., KIM, E. S., KOMAKI, R., ERASMUS, J. J., HOFSTETTER, W. L., RICE, D. C. & SWISHER, S. G. 2011. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol, 6, 1274-81.
QU, Y. J., LIU, G. B., SHI, H. S., LIAO, M. Y., YANG, G. F. & TIAN, Z. X. 2013. Preoperative CT findings of thymoma are correlated with postoperative Masaoka clinical stage. Acad Radiol, 20, 66-72.
MOON, JUNG WON et al. "Thymic Epithelial Tumors: Prognostic Determinants Among Clinical, Histopathologic, And Computed Tomography Findings". The Annals of Thoracic Surgery 99.2 (2015): 462-470. Web.
TAKAHASHI, K. & AL-JANABI, N. J. 2010. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging, 32, 1325-39.
SADOHARA, J., FUJIMOTO, K., MULLER, N. L., KATO, S., TAKAMORI, S., OHKUMA, K., TERASAKI, H. & HAYABUCHI, N. 2006. Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol, 60, 70-9.
BENVENISTE, M. F., MORAN, C. A., MAWLAWI, O., FOX, P. S., SWISHER, S. G., MUNDEN, R. F. & MAROM, E. M. 2013. FDG PET-CT aids in the preoperative assessment of patients with newly diagnosed thymic epithelial malignancies. J Thorac Oncol, 8, 502-10.
PURANDARE, NC et al. "Thymic Epithelial Tumors: Can Fluorodeoxyglucose Positron Emission Tomography Help In Predicting Histologic Type And Stage?". Indian Journal of Cancer 53.2 (2016): 270. Web.
GIRARD, N., TERUYA-FELDSTEIN, J., PAYABYAB, E. C., RIELY, G. J., RUSCH, V. W., KRIS, M. G. & ZAKOWSKI, M. F. 2010. Insulin-like growth factor-1 receptor expression in thymic malignancies. J Thorac Oncol, 5, 1439-46.
GIRARD, N., MORNEX, F., VAN HOUTTE, P., CORDIER, J. F. & VAN SCHIL, P. 2009. Thymoma: a focus on current therapeutic management. J Thorac Oncol, 4, 119-26.