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Original Research: Lung Cancer |

Cross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning

Ahmed H. El-Sherief, MD; Charles T. Lau, MD; Nancy A. Obuchowski, PhD; Atul C. Mehta, MD; Thomas W. Rice, MD; Eugene H. Blackstone, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aSection of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH

bDepartment of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH

cSection of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH

dSection of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH

eSection of Thoracic Imaging, Department of Diagnostic Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA

fDavid Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA

CORRESPONDENCE TO: Ahmed H. El-Sherief, MD, Department of Diagnostic Radiology, Section of Thoracic Imaging, Greater Los Angeles Veterans Administration Healthcare System, 11301 Wilshire Blvd, Bldg 500, Los Angeles, CA 90073


Copyright 2016, . All Rights Reserved.


Chest. 2017;151(4):776-785. doi:10.1016/j.chest.2016.09.016
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Background  Accurate and consistent regional lymph node classification is an important element in the staging and multidisciplinary management of lung cancer. Regional lymph node definition sets—lymph node maps—have been created to standardize regional lymph node classification. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a lymph node map to supersede all preexisting lymph node maps. Our aim was to study if and how lung cancer specialists apply the IASLC lymph node map when classifying thoracic lymph nodes encountered on CT scans during lung cancer staging.

Methods  From April 2013 through July 2013, invitations were distributed to all members of the Fleischner Society, Society of Thoracic Radiology, General Thoracic Surgical Club, and the American Association of Bronchology and Interventional Pulmonology to participate in an anonymous online image-based and text-based 20-question survey regarding lymph node classification for lung cancer staging on CT imaging.

Results  Three hundred thirty-seven people responded (approximately 25% participation). Respondents consisted of self-reported thoracic radiologists (n = 158), thoracic surgeons (n = 102), and pulmonologists who perform endobronchial ultrasonography (n = 77). Half of the respondents (50%; 95% CI, 44%-55%) reported using the IASLC lymph node map in daily practice, with no significant differences between subspecialties. A disparity was observed between the IASLC definition sets and their interpretation and application on CT scans, in particular for lymph nodes near the thoracic inlet, anterior to the trachea, anterior to the tracheal bifurcation, near the ligamentum arteriosum, between the bronchus intermedius and esophagus, in the internal mammary space, and adjacent to the heart.

Conclusions  Use of older lymph node maps and inconsistencies in interpretation and application of definitions in the IASLC lymph node map may potentially lead to misclassification of stage and suboptimal management of lung cancer in some patients.

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