Regional lymph node sampling in lung carcinoma: a single institutional and national database comparison
Dustin E Bosch1, Farhood Farjah2, Douglas E Wood2
1Department of Pathology, University of Washington, Seattle, WA 98195, USA.
Human Pathology
|February 16, 2018
Summary
Assessing regional lymph node counts in lung carcinoma is crucial. This study found no survival benefit for sampling at least 10 nodes, challenging current quality metrics.
Area of Science:
- Oncology
- Surgical Pathology
Background:
- Regional lymph node metastasis assessment is vital for lung carcinoma staging and prognosis.
- Current guidelines suggest sampling 10 regional lymph nodes for stage I-II lung carcinoma, but mediastinal sampling extent is debated.
Purpose of the Study:
- To evaluate factors influencing regional lymph node counts in lung carcinoma.
- To determine the impact of lymph node counts on patient survival.
Main Methods:
- Analysis of an institutional cohort (888 cases) and the Surveillance, Epidemiology, and End Results (SEER) national registry (10,856 cases).
- Assessment of clinical and pathologic factors correlating with lymph node counts.
- Survival analysis comparing different lymph node count thresholds.
Main Results:
- Lymph node counts varied significantly, with medians of 10 (institutional) and 7-14 (SEER).
- Total lymph node counts of 10 or more did not correlate with improved overall survival in the institutional cohort.
- In the SEER database, 0 nodes correlated with reduced survival, but 1-9 nodes showed no significant difference compared to >=10 nodes.
Conclusions:
- Lung carcinoma lymph node counts are influenced by surgical, pathologic, and biologic variability.
- The study found no evidence supporting a 10-lymph node count as a meaningful quality metric at institutional or national levels.
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