Early compliance with lung cancer lymph node standard 5.8: An analysis of 2022 and 2023 Commission on Cancer site reviews

Alison S Baskin ¹, Elizabeth C Funk ², Amanda B Francescatti ²

¹Department of Surgery, University of California, San Francisco, San Francisco, Calif; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich.
²Cancer Research Program, American College of Surgeons, Chicago, Ill.
³Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich.
⁴Cancer Research Program, American College of Surgeons, Chicago, Ill; Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minn.
⁵Cancer Research Program, American College of Surgeons, Chicago, Ill; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex.
⁶Cancer Research Program, American College of Surgeons, Chicago, Ill; Department of Surgery, University of Iowa, Iowa City, Iowa.
⁷Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich; Cancer Research Program, American College of Surgeons, Chicago, Ill; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, Michigan Medicine, Ann Arbor, Mich.
⁸Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn; Commission on Cancer, American College of Surgeons, Chicago, Ill.

⁰Department of Surgery, University of California, San Francisco, San Francisco, Calif; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Mich.

The Journal of Thoracic and Cardiovascular Surgery +

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May 5, 2025

View abstract on PubMed

Summary

Nearly half of Commission on Cancer sites are not meeting Standard 5.8 for lung cancer lymph node sampling. Improving compliance with this standard is crucial for accurate surgical staging and patient care.

Area Of Science

Oncology
Surgical Pathology
Quality Improvement

Background

Variability in lymph node staging for lung cancer impacts treatment decisions.
The Commission on Cancer implemented Standard 5.8 in 2021 to standardize nodal evaluation.
Standard 5.8 mandates sampling from ≥3 mediastinal and ≥1 hilar station in synoptic reports.

Purpose Of The Study

To evaluate the early implementation and compliance rates of Commission on Cancer Standard 5.8.
To assess the effectiveness of the new standard in improving lung cancer nodal staging.

Main Methods

Compliance data from Commission on Cancer site reviews in 2022-2023 were analyzed.
Up to 7 eligible pathology reports per site were reviewed against Standard 5.8 criteria.
Site compliance required 5/7 reports in 2022 and 6/7 reports in 2023 to meet the standard.

Main Results

Of 504 eligible sites, 54% were compliant, and 46% were noncompliant.
Noncompliant sites had a median adherence rate of 29% to the standard.
While adherence increased, overall site compliance decreased in 2023 due to a higher threshold.

Conclusions

A significant proportion of Commission on Cancer sites are not meeting Standard 5.8.
There is a substantial opportunity to enhance the quality of lymph node evaluations in lung cancer surgery.
Quality improvement initiatives and resources are needed to support hospitals in meeting Standard 5.8.

Keywords:

Commission on Cancer Operative Standard accreditation compliance lung cancer lymph node staging quality improvement