Role of intrapulmonary lymph node retrieval for pathological examination in resectable non-small cell lung cancer

Abstract

Lymph node (LN) metastasis is a prognostic factor for tumor recurrence and overall survival (OS) in resectable non-small cell lung cancer (NSCLC) patients (1,2). It also affects the decision of prescribing adjuvant or neo-adjuvant systemic chemotherapy or radiotherapy. Current studies and guidelines suggest that systematic LN dissection or sampling should be performed in resectable NSCLC (3,4). It is indicated that mediastinal LN (stations 2-9 or N2) (5,6) should be dissected when performing curative pulmonary resection in order to accurately determine tumor stage. For intrapulmonary LN or N1, stations 10-12 are usually dissected because they are easily identified and collected; however, the dissection of stations 13-14 is quite difficult and requires adequate training (7). A recent study showed that standard pathology practice frequently omitted to examine 60% of intrapulmonary LNs in 90% of lobectomy specimens, and found unexpected LN metastases in 12 % of reported node-negative patients (8). Nodal metastases affect the classification of the case into N2 or N1 disease, which in turn affects treatment strategies, tumor recurrence, and survival. It often happens that in N1 disease stations 13 and 14 are neglected, leading to disease under staging, and lack of prescription of adjuvant therapy. These may contribute to the observation that some of patients with N0 disease develop early tumor recurrence or distant metastases (8).In the paper entitled "Impact

Perspective and clinical relevance of intrapulmonary lymph node retrieval: response to the editorial by Tantraworasin and colleagues and the editorial by Marc Riquet and colleagues

“…Academic discussion about clinical relevance of intrapulmonary lymph node retrieval will help the community to increase the awareness of this easy-to-be-neglected area in our practice. Dr. Tantraworasin et al (1) and Dr. Riquet et al (2) both contribute their thoughts on this important topic. As they mentioned in the editorials, these lymph nodes deserve special attention because they occupy a unique place not only with regard to the prognosis of the NSCLCs when they are metastatic but also because of their anatomical and pathogenic characteristics (2).…”