Edward Robbins

Use of a Surgical Specimen-Collection Kit to Improve Mediastinal Lymph-Node Examination of Resectable Lung Cancer

Introduction: Pathologic examination of mediastinal lymph nodes (MLNs) after resection of non–small-cell lung cancer is critical in the determination of prognosis and postoperative management. Although systematic nodal dissection is recommended, the quality of pathologic lymph-node staging often falls short of recommendations in practice. We tested the feasibility of improving pathologic lymph-node staging of resectable non–small-cell lung cancer by using a prelabeled specimen-collection kit. Methods: Case-control study with comparison of 51 resections, using a special lymph-node collection kit, with 51 controls matched for surgeon, extent of resection, pathologist, and T category. Appropriate statistical methods were used for all comparisons. Results: The median number of MLNs examined increased from one in the control group, to six in the case group (p < 0.001). The percentage of resections attaining the National Comprehensive Cancer Network-recommended quality of MLN examination, and the proportion that would have been eligible for recent landmark postresection adjuvant therapy trials increased significantly (p < 0.001). The duration of surgery and postoperative complication rates were similar between cases and controls. Eighteen percent of kit cases had positive MLN, compared with 8% of controls. Conclusions: The use of a specialized specimen-collection kit for MLN examination was feasible, markedly improved MLN staging, and showed a trend toward increased detection of patients with MLN metastasis, with only a modest increase in duration of surgery, and no increase in perioperative morbidity, mortality, or hospital length of stay.

PS01.39: Reach and Adoption of a Surgical Intervention to Improve Pathologic Nodal Staging Across Healthcare Systems within the US Mid-South: Topic: Surgery

infiltrative mass in the mediastinum measuring 11.5 11.5 cm with diffuse uptake, and active lesions in the lung, liver, and bone. The patient was started on treatment for TC comprising temozolomide + capecitabine, octreotide long-acting repeatable, and denosumab. Everolimus will be considered upon disease progression. Conclusion: The indolent disease behavior throughout the course of several treatments for high-grade lung NET without an impressive response led to a suspicion, then confirmed diagnosis, of a low-grade TC in this patient. While lung NET differentiation can be challenging, early suspicion in patients who neither respond nor progress on a platinum + etoposide-based doublet therapy can avoid unnecessary toxicity and the associated poor quality of life.