CASE REPORT article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1582033
This article is part of the Research TopicTailored Strategies for Lung Cancer Diagnosis and Treatment in Special PopulationsView all 3 articles
Occult Lymph Nodal Metastasis in Sub-centimeter Lung Cancer: A Report of Seven Cases and Review of Literature
Provisionally accepted
Xiao Wang
Zhengcheng Liu*- Nanjing Medical University, Nanjing, China
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Background: Occult lymph node metastasis (OLNM) after surgery for stage IA subcentimeter lung cancer is an extremely rare clinical situation, with few reported cases in the literature. Further investigation is warranted into the clinical characteristics of patients and the radiological features of lung nodules. Here, we aim to provide a comprehensive insight into this tumor type.We present cases that sub-centimeter non-small cell lung cancer (NSCLC) patients who underwent surgery at our center and were found to have OLNM in postoperative pathology. This is the first time such cases have been reported. We reviewed the existing literature on this rare event and collected detailed clinical, histopathological, and radiological data for analysis.Results: A total of 7 sub-centimeter lung cancer patients were diagnosed with OLNM based on routine pathology, including 1 male and 6 females, with an average age of 58.7±9.3 years. All patients had no clinical symptoms and were found by physical examination, with follow-up durations ranging from 1 week to 3 years. Among these patients, 4 exhibited mediastinal lymph node metastasis. Preoperative chest CT in all patients showed pure-solid nodules (PSN), and 6 patients changed the surgical procedure based on intraoperative frozen sections results. Routine pathology revealed that all adenocarcinoma patients presented high-risk factors for recurrence, including visceral pleural invasion (VPI), spread through air spaces (STAS), vascular invasion, and poorly differentiated tumor.Sub-centimeter lung cancers with radiological feature of PSN are at risk for lymph node metastasis. Surgeons should pay close attention to intraoperative rapid pathology results to prevent inadequate surgical treatment. Adenocarcinoma patients often present with one or more high-risk factors for recurrence, active adjuvant treatment and follow-up are necessary.
Keywords: sub-centimeter lung cancer, lymph node metastasis, Pathology, Radiology, case report
Received: 23 Feb 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Wang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhengcheng Liu, Nanjing Medical University, Nanjing, China
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