Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11629

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    P2.07-034 - Audit of mediastinal lymph node (MLN) examination in non-small cell lung cancer (NSCLC) resections using a specimen collection kit and checklist intervention. (ID 2854)

    09:30 - 09:30  |  Author(s): J.B. Putnam
    • Abstract

    Background
    Optimal pathologic nodal staging of NSCLC requires MLN dissection (MLND) or systematic sampling (SS). In our prior audit of a citywide database, 45% of resections were claimed by surgeons as MLND, none of which met pathology criteria, only 9% of all resections met SS criteria, 50% of all resections had random sampling (RS) and 42% had no sampling (NS) of MLN. An independent surgeon audit suggested that 29% of operation notes described a MLND, but 26% were RS and 45% NS. The concordance rate for MLND or SS between surgeon claims and pathology report audit was only 11%. We examined the impact of corrective intervention with a pre-labeled lymph node specimen collection kit and a checklist on the verifiable quality of MLN examination in a repeat audit of surgeon claims.

    Methods
    Prospective cohort study of NSCLC resections performed with the kit at 4 Memphis, TN hospitals from 11/2010 - 01/2013. Surgeons, operating room and pathology staff received training on the value of rigorous MLN examination and proper kit use. Surgeons marked the stations harvested on a checklist during the operation. Resections were classified into 4 pre-defined groups based on MLN stations marked on the checklist (surgeon claims), and the pathology report: MLND, SS (both by ACOSOG Z0030 trial criteria), RS (>0 MLN present, but MLND/SS criteria not met), NS (0 MLN present). Audited operation notes were categorized by surgeons from two independent academic cancer centers into one of the 4 MLN examination groups. The primary endpoints were the verifiable rate of MLND + SS and the concordance rate between observers.

    Results
    N = 161; 51% female, median Charlson comorbidity score 2 (IQR 1-3), 58% right-side resections. Clinico-demographic characteristics were similar between patients in each MLN category. Surgeons claimed MLND in 49%, SS in 9% of cases; vs 76% and 14% in the independent surgeon audit. The kappa score between independent surgeons was 0.44 ('moderate agreement'). Figure 1

    Conclusion
    The verifiable MLND+SS rate increased from 9% in the previous pathology audit to 83%; and from 29% in the previous independent surgeon audit to 89%. Concordance between operating surgeon claims and the pathology report increased from 11% to 83%. The improved lymph node yield and verifiable quality of MLN mapping indicates that implementing a corrective intervention with a pre-labelled specimen collection kit and checklist improves surgical MLN collection practice, fosters better communication with pathologists and improves the quality of pathologic nodal staging of NSCLC.