Regional lymph node sampling in lung carcinoma: a single institutional and national database comparison

Publication date: Available online 13 February 2018
Source:Human Pathology
Author(s): Dustin E. Bosch, Farhood Farjah, Douglas E. Wood, Rodney A. Schmidt
Assessing regional lymph node metastasis is a key component of lung carcinoma staging and prognostication. Recent guidelines have suggested a quality metric of 10 total regional lymph nodes sampled with each stage I-II primary lung carcinoma resection. However, the extent of mediastinal lymph node sampling remains controversial. We assessed factors contributing to regional lymph node counts and effect on overall patient survival in an institutional cohort of 888 cases and the Surveillance, Epidemiology, and End Results (SEER) national cancer registry (10 856 cases). The distribution of total lymph node counts in lobectomy and pneumonectomy cases was variable with median 10, interquartile range 7–14. Multiple clinical and pathologic factors correlated to total regional node counts. Total lymph node counts ≥10 in the institutional cohort did not correlate to significant differences in overall survival as compared to node counts <10 (P = .38). In the SEER database, although 0 regional lymph nodes reported correlated to reduced overall survival (hazard ratio 1.47, P < .01), no significant difference was detected for 1–9 versus ≥10 nodes (P = .8). In conclusion, lymph node counts for primary lung carcinoma are driven by surgical, pathological, and biological variability. We find no evidence for a meaningful quality metric of 10 total regional lymph nodes at the institutional and national registry levels.



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