e17531^ Background: The number of LNs examined following lung cancer resection has prognostic value. The International Association for the Study of Lung Cancer (IASCLC) recommends a minimum of 6 LNs and other series have recommended greater than 11. Most resections in the United States fail to meet these recommendations. We hypothesized that simple interventions could improve on the number of LNs examined. Methods: We used a pre-labeled specimen collection kit to aid in collection of N2 LNs and developed a re-dissection protocol to retrieve discarded N1 LNs. We performed a 3 era case control study: Era 1, routine surgical examination (RSE) + routine pathology examination. Era 2, RSE + special pathology examination (SPE). Era 3, SPE + special surgical examination. The Chi-Square, Fishers Exact, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used where appropriate for comparisons. Results: Patient demographic and tumor characteristics were similar across three groups. Significantly more N1 and total LNs were examined in eras 2 and 3 compared to era 1 (Table). Significantly more N2 LNs were examined in era 3 compared to eras 1 and 2. There was a non-significant trend toward detection of metastatic LNs. More cases met both IASLC recommendations and had at least 11 LNs examined LNs in eras 2 and 3 compared to era 1. Conclusions: The interventions were feasible and effective in improving LN examination. The number of LNs examined using these interventions exceeded consensus recommendations. A phase III trial incorporating these interventions is being designed. [Table: see text]
Advances in Lung Cancer Biopsy Techniques and Specimen Collection Methods
