In this issue of CHEST, El-Sherief et al challenged real-life interpretation of the IASLC lymph node map by showing illustrative cases that deal with terminology and classification to various specialists in lung cancer management. By creating an online questionnaire which included image- and text-based cases, the authors asked members of professional societies in North America in the fields of thoracic radiology, thoracic surgery, and invasive pulmonology to name the stations and classify the N stage of the presented cases. The responses to this questionnaire revealed huge gaps between the desired optimal oncologic patient care and current daily practice. Only one-half of the respondents from all disciplines reported using the IASLC lymph node map in daily practice, whereas approximately one-third of them still use the MD-ATS system. Surprisingly, the rate of correct answers to unambiguous classifications, such as right- vs left-sided paratracheal lymph nodes, was no more than 45%, even among those using the IASLC lymph node map. When challenged by ambiguous or missing IASLC map definitions, the rates of stage misclassification (N1 vs N2, N2 vs N3, and even N vs M), which can lead to suboptimal management of patients with lung cancer, were devastatingly high (often > 50% of responders replying incorrectly in reference to the authors’ definitions). Lung specialists from Europe and Japan are not represented in this report.