Maximizing Lymph Node Dissection on Fresh and Fixed Lung Cancer Resection Specimens
Brigham and Women's Hospital
Summary
Lung cancer patients undergoing upfront surgery, highly benefit from a systematic lymph node dissection in the mediastinum and in the surgical specimens. The latter is performed by the pathologist. Developing a standardized technique to dissect the lobectomy specimen has the potential of maximizing the retrieval of all N1 stations lymph nodes. The investigators believe that the adoption of such technique will improve lung cancer staging and identify a higher number of patients that qualify for adjuvant therapies.
Description
Anatomic lung resection with systematic mediastinal lymph node dissection is the standard of care for patients with clinical stage I or II non-small cell lung cancer (NSCLC). While the best type of resection may sometimes be debated, it is clear that mediastinal, hilar, and lobar lymph nodes (LNs) should be routinely retrieved to achieve a complete lung cancer resection. According to major international guidelines, at least 3 hilar/intrapulmonary stations and 3 mediastinal stations should be assessed during resection. Although there is still a debate over whether the ideal number of LN station…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: 1. Subjects with a lung nodule or mass who are eligible to undergo a lobectomy. 2. Subject without any metastasis present. 3. Subjects who have peripheral lung nodule location 4. Subjects must be 18 years of age or older. Exclusion Criteria: 1. Subjects who received preoperative chemotherapy or radiotherapy. 2. Subjects who have a lung nodule located in a central location. Central tumors are defined by those infiltrating the lobar airway.
Interventions
- OtherSubjects undergoing a lung specimen lymph node dissection
A lobectomy specimen's resection will undergo systematic lymph node dissection either by the patient's treating thoracic surgeon and/or by a member of the pathology team. The protocol for a standardized lymph node dissection consists of a series of blunt peribronchial dissections starting from the hilum to the periphery, with particular attention to points of airway bifurcation where intrapulmonary lymph nodes aggregate. By emphasizing the intrapulmonary lymph node map and a standardized dissection, the team will remove more lymph nodes from the lobectomy specimen, resulting in an accurate N staging.
- OtherControl group
Control group
Location
- Brigham and Womens HospitalBoston, Massachusetts