title: The impact of a novel lung gross dissection protocol on intrapulmonary lymph node retrieval from lung cancer resection specimens.
abstract: Although thorough pathologic nodal staging provides the greatest prognostic information in patients with potentially curable non-small cell lung cancer, N1 nodal metastasis is frequently missed. We tested the impact of corrective intervention with a novel pathology gross dissection protocol on intrapulmonary lymph node retrieval. This study is a retrospective review of consecutive lobectomy, or greater, lung resection specimens over a period of 15 months before and 15 months after training pathologist's assistants on the novel dissection protocol. One hundred forty one specimens were examined before and 121 specimens after introduction of the novel dissection protocol. The median number of intrapulmonary lymph nodes retrieved increased from 2 to 5 (P<.0001), and the 75th to 100th percentile range of detected intrapulmonary lymph node metastasis increased from 0 to 5 to 0 to 17 (P=.0003). In multivariate analysis, the extent of resection, examination period (preintervention or postintervention), and pathologic N1 (vs N0) status were most strongly associated with a higher number of intrapulmonary lymph nodes examined. A novel pathology dissection protocol is a feasible and effective means of improving the retrieval of intrapulmonary lymph nodes for examination. Further studies to enhance dissemination and implementation of this novel pathology dissection protocol are warranted.
authors.affiliation: Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN; Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN. Electronic address: rosarogi@bmhcc.org.
authors.forename: Raymond U
authors.initials: RU
authors.lastname: Osarogiagbon
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN.
authors.forename: Ransome
authors.initials: R
authors.lastname: Eke
authors.affiliation: Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
authors.forename: Srishti
authors.initials: S
authors.lastname: Sareen
authors.affiliation: Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Leary
authors.affiliation: Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
authors.forename: LaShundra
authors.initials: L
authors.lastname: Coleman
authors.affiliation: Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Faris
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, TN.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Yu
authors.affiliation: Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN.
authors.forename: David
authors.initials: D
authors.lastname: Spencer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010340:Pathology, Surgical / Q000379:methods*; D012189:Retrospective Studies
keywords: Non–small cell lung cancer; Pathologic nodal staging; Quality improvement