Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study

Abstract

Introduction: Suboptimal pathologic nodal staging prevails after curative-intent resection of lung cancer. We evaluated the impact of a lymph node specimen collection kit on lung cancer surgery outcomes in a prospective, populationbased, staggered implementation study. Methods: From January 1, 2014, to August 28, 2018, we implemented the kit in three homogeneous institutional cohorts involving 11 eligible hospitals from four contiguous hospital referral regions. Our primary outcome was pathologic nodal staging quality, defined by the following evidence-based measures: the number of lymph nodes or stations examined, proportions with poor-quality markers such as nonexamination of lymph nodes, and aggregate quality benchmarks including the National Comprehensive Cancer Network criteria. Additional outcomes included perioperative complications, health care utilization, and overall survival. Results: Of 1492 participants, 56% had resection with the kit and 44% without. Pathologic nodal staging quality was significantly higher in the kit cases: 0.2% of kit cases versus 9.8% of nonkit cases had no lymph nodes examined; 3.2% versus 25.3% had no mediastinal lymph nodes; 75% versus 26% attained the National Comprehensive Cancer Network criteria (p < 0.0001 for all comparisons). Kit cases revealed no difference in perioperative complications or health care *Corresponding author. Disclosure: Dr. Osarogiagbon owns patents for the lymph node specimen collection kit; owns stocks in Eli Lilly, Gilead Sciences, and Pfizer; has worked as a paid research consultant for the American Cancer Society,

Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)

“…Finally, this analysis examined process outcomes, including delivery of surgery and adjuvant chemotherapy, rather than clinical outcomes, such as survival. Still, associations between these process metrics and clinical outcomes have been described previously, and these associations will be examined as part of a planned survival analysis of the overall ALCHEMIST trial once there is a sufficient number of events.…”

A Review on Laser-Induced Breakdown Spectroscopy in Different Cancers Diagnosis and Classification

“…The line between the lung tumour and the border tissue is blurry, during surgery. Recurrence can shorten a patient's life if tumour excision is incomplete [77]. Lin et al [36] used LIBS combined with machine learning techniques to differentiate lung boundaries from lung tissues.…”

Trends in Accuracy and Comprehensiveness of Pathology Reports for Resected NSCLC in a High Mortality Area of the United States

“…The MS-QSR is an ongoing population-based cohort, involving a diverse group of hospitals in this high U.S. lung cancer incidence and mortality region. 10 , 9 All data, including reported CAP checklist items from the final pathology report, were retrieved by trained data abstractors using a standardized template. The MS-QSR is systematically, independently, and periodically audited for accuracy.…”

“…The MS-QSR is systematically, independently, and periodically audited for accuracy. 10 , 9 All aspects of this study were conducted with oversight and approval from the institutional review boards of all participating hospitals and the University of Memphis.…”