Use of a surgical specimen-collection kit to improve mediastinal lymph-node examination of resectable lung cancer.
BACKGROUND
Pathologic examination of mediastinal lymph nodes (MLNs) after resection of non-small-cell lung cancer is critical in the determination of prognosis and postoperative management. Although systematic nodal dissection is recommended, the quality of pathologic lymph-node staging often falls short of recommendations in practice. We tested the feasibility of improving pathologic lymph-node staging of resectable non-small-cell lung cancer by using a prelabeled specimen-collection kit.


METHODS
Case-control study with comparison of 51 resections, using a special lymph-node collection kit, with 51 controls matched for surgeon, extent of resection, pathologist, and T category. Appropriate statistical methods were used for all comparisons.


RESULTS
The median number of MLNs examined increased from one in the control group, to six in the case group (p < 0.001). The percentage of resections attaining the National Comprehensive Cancer Network-recommended quality of MLN examination, and the proportion that would have been eligible for recent landmark postresection adjuvant therapy trials increased significantly (p < 0.001). The duration of surgery and postoperative complication rates were similar between cases and controls. Eighteen percent of kit cases had positive MLN, compared with 8% of controls.


CONCLUSIONS
The use of a specialized specimen-collection kit for MLN examination was feasible, markedly improved MLN staging, and showed a trend toward increased detection of patients with MLN metastasis, with only a modest increase in duration of surgery, and no increase in perioperative morbidity, mortality, or hospital length of stay.
The Multidisciplinary Thoracic Oncology Program, Boston Baskin Cancer Foundation, Baptist Cancer Center, Memphis, TN 38120 , USA. rosarogi@bmg.md
Raymond U
RU
Osarogiagbon
Laura E
LE
Miller
Robert A
RA
Ramirez
Christopher G
CG
Wang
Thomas F
TF
O'Brien
Xinhua
X
Yu
Alim
A
Khandekar
Glenn P
GP
Schoettle
Samuel G
SG
Robbins
Edward T
ET
Robbins
Jeffrey B
JB
Gibson
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D013048:Specimen Handling / Q000379:methods*