title: Audit of lymphadenectomy in lung cancer resections using a specimen collection kit and checklist.
abstract: BACKGROUND
  Audits of operative summaries and pathology reports reveal wide discordance in identifying the extent of lymphadenectomy performed (the communication gap). We tested the ability of a prelabeled lymph node specimen collection kit and checklist to narrow the communication gap between operating surgeons, pathologists, and auditors of surgeons' operation notes.
  
  
  METHODS
  We conducted a prospective single cohort study of lung cancer resections performed with a lymph node collection kit from November 2010 to January 2013. We used the kappa statistic to compare surgeon claims on a checklist of lymph node stations harvested intraoperatively with pathology reports and an independent audit of surgeons' operative summaries. Lymph node collection procedures were classified into four groups based on the anatomic origin of resected lymph nodes: mediastinal lymph node dissection, systematic sampling, random sampling, and no sampling.
  
  
  RESULTS
  From the pathology reports, 73% of 160 resections had a mediastinal lymph node dissection or systematic sampling procedure, 27% had random sampling. The concordance with surgeon claims was 80% (kappa statistic 0.69, 95% confidence interval: 0.60 to 0.79). Concordance between independent audits of the operation notes and either the pathology report (kappa 0.14, 95% confidence interval: 0.04 to 0.23) or surgeon claims (kappa 0.09, 95% confidence interval: 0.03 to 0.22) was poor.
  
  
  CONCLUSIONS
  A prelabeled specimen collection kit and checklist significantly narrowed the communication gap between surgeons and pathologists in identifying the extent of lymphadenectomy. Audit of surgeons' operation notes did not accurately reflect the procedure performed, bringing its value for quality improvement work into question.
authors.affiliation: Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee; School of Public Health, University of Memphis, Memphis, Tennessee. Electronic address: rosarogi@bmhcc.org.
authors.forename: Raymond U
authors.initials: RU
authors.lastname: Osarogiagbon
authors.affiliation: Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
authors.forename: Srishti
authors.initials: S
authors.lastname: Sareen
authors.affiliation: School of Public Health, University of Memphis, Memphis, Tennessee.
authors.forename: Ransome
authors.initials: R
authors.lastname: Eke
authors.affiliation: School of Public Health, University of Memphis, Memphis, Tennessee.
authors.forename: Xinhua
authors.initials: X
authors.lastname: Yu
authors.affiliation: Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
authors.forename: Laura M
authors.initials: LM
authors.lastname: McHugh
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Kemp H
authors.initials: KH
authors.lastname: Kernstine
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.affiliation: Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Robbins
mesh_terms: D000368:Aged; D057189:Checklist; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000592:standards* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008485:Medical Audit; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013048:Specimen Handling / Q000592:standards*