title: Improving the pathologic evaluation of lung cancer resection specimens.
abstract: Accurate post-operative prognostication and management heavily depend on pathologic nodal stage. Patients with nodal metastasis benefit from post-operative adjuvant chemotherapy, those with mediastinal nodal involvement may also benefit from adjuvant radiation therapy. However, the quality of pathologic nodal staging varies significantly, with major survival implications in large populations of patients. We describe the quality gap in pathologic nodal staging, and provide evidence of its potential reversibility by targeted corrective interventions. One intervention, designed to improve the surgical lymphadenectomy, specimen labeling, and secure transfer between the operating theatre and the pathology laboratory, involves use of pre-labeled specimen collection kits. Another intervention involves application of an improved method of gross dissection of lung resection specimens, to reduce the inadvertent loss of intrapulmonary lymph nodes to histologic examination for metastasis. These corrective interventions are the subject of a regional dissemination and implementation project in diverse healthcare systems in a tri-state region of the United States with some of the highest lung cancer incidence and mortality rates. We discuss the potential of these interventions to significantly improve the accuracy of pathologic nodal staging, risk stratification, and the quality of specimens available for development of stage-independent prognostic markers in lung cancer.
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Raymond U
authors.initials: RU
authors.lastname: Osarogiagbon
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hilsenbeck
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Sales
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Berry
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Jarrett
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Giampapa
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: Clara N
authors.initials: CN
authors.lastname: Finch-Cruz
authors.affiliation: 1 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 2 Duckworth Pathology Group, Memphis, TN, USA ; 3 Doctors Anatomic Pathology, Jonesboro, AR, USA ; 4 Department of Pathology, St. Francis Hospital, Memphis, TN, USA ; 5 Pathology and Clinical Laboratories, North Mississippi Medical Center, Tupelo, MS, USA ; 6 Medical Center Laboratory, Jackson-Madison County General Hospital, Jackson, TN, USA ; 7 Pathology and Laboratory Medicine Service, Department of Veterans Affairs, VA Medical Center Memphis, TN, USA ; 8 Trumbull Laboratories, LLC/Pathology Group of the Mid-South, Memphis, TN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Spencer
keywords: Quality of care; lung cancer surgery; nodal staging; survival