Does This Lymph Node Look Bulky to You? What Should We Do About It? A Survey of Thoracic Surgeons

Clinical lung cancer staging plays an integral role in determining surgical candidacy for patients with non-small cell lung cancer. Bulky or multistation mediastinal lymph nodes (LNs) may influence surgical candidacy. However, these characteristics lack standardized definitions. The objective of this study was to describe surgeons' perspectives on how they use these terms in their practices.

A 24-item survey was developed and distributed to surgeons participating in The Society of Thoracic Surgeons email list. The survey aimed to determine how surgeons define bulky mediastinal or multistation lymphadenopathy and how these definitions affect their decision to operate. Comparisons of how respondents defined LN characteristics were made by demographic and practice characteristics using the χ² and Fisher exact tests.

The survey was sent to 1336 individuals, opened by 653 (48.9%), and completed by 165 (5.9%), for an overall 12.4% response rate. Almost all respondents were general thoracic surgeons (n = 161; 98.2%). Most respondents agreed on the definition of an enlarged LN as ≥1 cm (n = 149; 90.3%). More variation was observed in the definition of bulky LN: 39% (n = 64) used a threshold of ≥2 cm, 24% (n = 40) used ≥3 cm, and approximately 33% (n = 53) did not define bulky by size criteria alone. Most respondents considered 2 or more LN stations as multistation disease (n = 147; 89.1%). LN status appeared to be a substantial factor influencing which patients are surgical candidates.

This study documented significant variation in how surgeons define bulky lymphadenopathy and its influence on treatment decisions and highlighted the need for standardized definitions.