Mayo Clin Proc. • November 2004;79(11):1409-1414 • www.mayo.edu/proceedings 1409 AUTOPSY RESULTS OF NSCLC SURGICAL PATIENTS Autopsy Results After Surgery for Non–Small Cell Lung Cancer ORIGINAL ARTICLE From the Department of Laboratory Medicine and Pathology (N.M.F., M.-C.A., H.D.T.), Department of Radiology (G.L.A.), Division of Biostatistics (C.M.L., V.S.P.), and Division of General Thoracic Surgery (C.D.), Mayo Clinic College of Medicine, Rochester, Minn. Dr Finke is now with the Elmhurst Memorial Ho s pital, Elmhurs t, Ill. Address reprint requests and correspondence to Marie-Christine Aubry, MD, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905 (e-mail: aubry.mariechristine @mayo.edu). © 2004 Mayo Foundation for Medical Education and Research NICOLE M. FINKE, MD; MARIE-CHRISTINE AUBRY, MD; HENRY D. TAZELAAR, MD; GREGORY L. AUGHENBAUGH, MD; CHRISTINE M. LOHSE, BS; V. SHANE PANKRATZ, PHD; AND CLAUDE DESCHAMPS, MD OBJECTIVE: To determine the percentage of metastatic and unex- pected residual lung cancer at autopsy in patients considered for curative resection of non–small cell lung cancer during a time when computed tomography was available as a preoperative stag- ing tool. MATERIAL AND METHODS : Clinical data and surgical and autopsy slides of all patients who underwent curative resection of non– small cell lung cancer at the Mayo Clinic in Rochester, Minn, between 1985 and 1999 and who underwent autopsy within 30 days of surgery were reviewed retrospectively for the presence of residual or metastatic disease. RES ULTS : The study group consisted of 25 men and 7 women, with a mean age of 70 years. A pulmonary metastasis was identified at surgery in 1 patient (3%). Metastases were found in an additional 5 patients (16%) at autopsy, 1 of whom had 2 sites involved. These sites included the liver in 2 and lung, epicardium, adrenal gland, and kidney in 1 each. The average diameter of metastases was 1.6 cm. No factor studied was found to be significantly associated with the presence of unrecognized meta- static disease at autopsy. CONCLUS ION: The advent of computed tomography as a staging tool has decreased the percentage of patients with undiagnosed metastatic disease at surgery; however, preoperative understag- ing in lung cancer remains a problem. M ayo Clin Proc. 2004;79(11):1409-1414 CT = computed tomography; NSCLC = non–small cell lung cancer L ung cancer is the leading cause of death from cancer in both men and women in North America. An estimated 175,000 new cases of non–small cell lung cancer (NSCLC) are diagnosed each year in the United States alone. 1 Al- though surgical resection provides the best hope for cure, only one third of patients are candidates for definitive surgical management. 2 In one study, the overall cumulative 5-year survival rate for patients with primary lung cancer managed by resection increased from 23% in 1960 3 to 54% in 1990. 4 This increased survival rate was attributed to more accurate preoperative evaluation and staging of lung cancer. Before the introduction of computed tomography (CT) as a staging tool, one study showed that 49 (24%) of 202 patients who underwent curative resection of lung cancer and died within 30 days postoperatively were found to have unrecognized metastatic disease at autopsy. 5 In addition, residual disease at the site of previous resection was found in 24 (12%) of 202 patients. 5 The purpose of this study was to determine the percentage of metastatic and unexpected residual lung cancer at autopsy in patients con- sidered for curative resection of NSCLC during a period when CT was available as a preoperative staging tool. M ATERIAL AND M ETHODS Preoperative chest CT with routine evaluation of adrenal glands was introduced for patients undergoing clinical staging of lung cancer at the Mayo Clinic in Rochester, Minn, in the mid-1980s. Therefore, the period chosen for this retrospective study was from 1985 to 1999. This study was approved by the Mayo Foundation Institutional Re- view Board. Inclusion criteria included patients with a diagnosis of NSCLC who underwent curative surgery and who died within 30 days of the surgery and subsequently underwent an autopsy. Mayo Clinic pathology and surgical databases were searched to identify patients who met these criteria. Medical records were reviewed for age at diagnosis, sex, preoperative work-up, type of surgery, clinical and postsurgical tumor stage, and type of autopsy. Autopsies were either complete with evaluation of all organs or lim- ited to certain organs. All available CTs were reviewed by a chest radiologist (G.L.A.), and, when unavailable, data were collected from radiology reports. Radiological data included extent of CT (limited to chest, chest extending to upper abdomen, and complete abdomen), primary tumor site, size of primary tumor, presence and location of inde- terminate pulmonary nodules, adenopathy, and other nod- ules suggestive of metastatic disease. Hematoxylin-eosin–stained slides from the primary lung tumor and the autopsy specimens were also reviewed. Lung tumors were classified according to the most recent World Health Organization classification. 6 Residual dis- ease was defined as tumor present in tissue around the bronchial stump or tumor in mediastinal lymph nodes not sampled at surgery. Synchronous primary lung carcinoma was defined as carcinoma of a different histological sub- For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.