Invited paper ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer §

SummaryThe European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. Theobjective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and thepathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on thesubjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus.Systematicnodaldissectionisrecommendedinallcasestoensurecompleteresection.Lobe-specificsystematicnodaldissectionisacceptableforperipheralsquamousT1tumors,ifhilarandinterlobarnodesarenegativeonfrozensectionstudies;itimpliesremovalof,atleast,threehilarandinterlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies andsampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resectedseparately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does notdetect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolatedtumor cells in hematoxylin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patientswith these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging andpathologic evaluation, and improve pathologic staging, which will help decide on the best adjuvant therapy.# 2006 Elsevier B.V. All rights reserved.