Invasive Mediastinal Staging Guideline Concordance.

Area of Science:

• Thoracic Surgery
• Oncology
• Pulmonary Medicine

Background:

• Guidelines exist for preoperative invasive mediastinal staging (IMS) in non-small cell lung cancer (NSCLC).
• Concordance with these guidelines and the impact on identifying lymph node metastases require evaluation.
• This study assesses guideline adherence and nodal staging practices in NSCLC resections.

Purpose of the Study:

• To determine concordance with Cancer Care Ontario (CCO) invasive mediastinal staging (IMS) guidelines for non-small cell lung cancer (NSCLC).
• To identify reasons for nonconcordance with IMS guidelines.
• To evaluate intraoperative nodal sampling and final pathologic staging in patients who did not undergo preoperative IMS.

Main Methods:

• Retrospective review of 242 non-small cell lung cancer (NSCLC) resections between 2010-2012.
• Chart audit to assess adherence to Cancer Care Ontario (CCO) invasive mediastinal staging (IMS) guidelines.
• Pathologic report review for postresection nodal staging.

Main Results:

• 102 of 242 patients (42%) did not receive preoperative invasive mediastinal staging (IMS).
• Guideline concordance for IMS was high at 85% (206/242 patients), with 66 patients correctly not requiring IMS and 36 patients non-concordantly not receiving it.
• Of 102 patients without preoperative IMS, only 72 had intraoperative nodal assessment, and 35 (34%) had sampling of three or more N2 nodal stations.

Conclusions:

• Despite high guideline concordance for invasive mediastinal staging (IMS) in non-small cell lung cancer (NSCLC), a significant proportion of patients did not undergo the procedure.
• Intraoperative nodal sampling rates were lower than expected in patients not receiving preoperative IMS.
• Inadequate nodal sampling may result in understaged patients, highlighting a need for improved nodal assessment protocols.