title: Objective review of mediastinal lymph node examination in a lung cancer resection cohort.
abstract: BACKGROUND
  Accurate staging of resected lung cancer requires mediastinal lymph node (MLN) examination. MLN dissection (MLND) and systematic sampling (SS) are acceptable procedures; random sampling (RS) and no sampling (NS) are not. Forty percent of US lung cancer resections have NS. We closely examined the pattern of MLN examination in a lung resection cohort.
  
  
  METHODS
  This is a retrospective review of all lung cancer resections in Memphis, TN, from 2004 to 2007. We compared operating surgeons' claims to the pathology report and an audit of the operation narrative by an independent surgeon.
  
  
  RESULTS
  Forty-five percent of resections were reported by surgeons as MLND, 8% RS, and 48% NS. None met pathology criteria for MLND, 9% were SS, 50% were RS, and 42% were NS. The concordance rate between the operating surgeon and pathology report was 39%. The surgeon audit suggested 29% of resections had MLND, 26% RS, and 45% NS. Concordance between operating and auditing surgeons was 71%. Sublobar resection, T1 stage, and age were associated with NS.
  
  
  CONCLUSIONS
  Most resections had suboptimal MLN examination. Concordance was poor between surgeon claims, objective review of pathology reports, and an independent surgeon audit. The higher concordance between operating and auditing surgeons may suggest incomplete pathology examination of MLN material. The terms used by operating surgeons to describe MLN retrieval were often inaccurate.
authors.affiliation: Division of Oncology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA. rosarogi@uthsc.edu
authors.forename: Raymond U
authors.initials: RU
authors.lastname: Osarogiagbon
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Allen
authors.forename: Aamer
authors.initials: A
authors.lastname: Farooq
authors.forename: James T
authors.initials: JT
authors.lastname: Wu
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008482:Mediastinum / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate