• Tomohiro Haruki, Makoto Wakahara, Yuki Matsuoka, Ken Miwa, Kunio Araki, Yuji Taniguchi, and Hiroshige Nakamura.
• Department of Surgery, Division of General Thoracic Surgery, Fuculty of Medicine, Tottori University, Yonago, Tottori, Japan.
• Ann Thorac Cardiovasc Surg. 2017 Aug 20; 23 (4): 181-187.

PurposeThe objective is to demonstrate the clinicopathological characteristics of patients with unexpected node-positive lung adenocarcinoma and to analyze predictive factors of unexpected disease.MethodsWe reviewed 225 patients with lung adenocarcinoma who underwent curative-intent operation between January 2008 and December 2014. Unexpected node-positive diseases were defined as cases with hilar or mediastinal lymph nodes metastasis in spite of both negative significant enlargement of lymph nodes on preoperative chest computed tomography (CT) and negative fluorodeoxyglucose (FDG) uptake in lymph nodes on preoperative positron emission tomography (PET)/CT. We retrospectively analyzed clinical features of these patients and evaluated associated factors for unexpected diseases.ResultsThere were 41 patients (18%) with unexpected node-positive disease, consisting of 16 (39%) unexpected pN1 and 25 (61%) unexpected pN2 diseases. The most common predominant subtype was papillary (22 patients; 54%), and 17 patients (41%) had micropapillary component in the tumors. Younger age (p <0.01), left side (p <0.01), larger tumor size (p <0.01), and having a micropapillary component (p <0.01) were significant associated factors of unexpected diseases in multivariate analysis.ConclusionHistological findings of the primary tumor are often important because they can provide predictive information for lymph nodes status. Having a micropapillary component was one of the significant predictors of unexpected node-positive diseases.

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