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INTRAOPERATIVE LYMPH NODE STATUS IN NON-SMALL CELL LUNG CANCER

INTRAOPERATIVE LYMPH NODE STATUS IN NON-SMALL CELL LUNG CANCER. A. Akopov, I. Dvorakovskaya, I. Mosin, A. Andreassian Research Institute of Pulmonology, Saint-Petersburg, Russian Federation. Objective.

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INTRAOPERATIVE LYMPH NODE STATUS IN NON-SMALL CELL LUNG CANCER

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  1. INTRAOPERATIVE LYMPH NODE STATUS IN NON-SMALL CELL LUNG CANCER A. Akopov, I. Dvorakovskaya, I. Mosin, A. Andreassian Research Institute of Pulmonology, Saint-Petersburg, Russian Federation

  2. Objective • Intraoperative frozen section investigation allows immediate regional lymph node dissection when the sentinel node contains tumor. • The purpose of this study was to determine the efficacy of intraoperative lymph node frozen section diagnosis in non-small cell lung cancer patients.

  3. Method Prospective study with 109 consecutive patients with non-small cell lung cancer who had undergone a complete resection with a systematic mediastinallymph node dissection from 1997 to 2000. 68 patients (0,62) had squamous cell cancer 34 patients (0,31) had adenocarcinoma 7 patients (0,07) had large cell cancer 20 patients (0,18) were in stage pI 28 patients (0,26) were in stage pII 61 patients (0,56) were in stage pIIIa

  4. Method • After thoracotomy at least one mediastinal or hilar (sentinel) lymph node which was most likelihood of metastasis were assessed by frozen section investigation. • Nodes were bisected, and a complete cross-section was obtained for frozen section. Step sections at three levels were made of the remaining lymphatic tissue and were stained with hematoxylin and eosin. • Postoperative paraffin section with hematoxylin and eosin staining is undertaken as a final pathological diagnosis. • Frozen section (fN) and postoperative (pN) lymph node status were compared.

  5. Results • A total of 190 lymph nodes were assessed by frozensection investigation and 923 lymph nodes postoperatively. • Frozensection investigation revealed metastatic involvement of the lymph nodes in 77 patients (70,6%). • Postoperative investigation revealed metastatic involvement of the lymph nodes in 86 patients (78,9%).

  6. Frozen section fN0 disease identified in 32 patients (29,4%) fN1 disease identified in 33 patients (30,3%) fN2 disease identified in 44 patients (40,3%) Postoperative pN0 disease identified in 23 patients (21,1%) pN1 disease identified in 30 patients (27,5%) pN2 disease identified in 56 patients (51,4%) Results In 9 patients from fN0 metastases in lymph nodes were found postoperatively (false-negative fN0), all these patients had right lung tumors.

  7. Results Efficacy of frozen section investigation in determining N-positive lymph node status Accuracy = (23 + 77) : 109 = 91,7 % (for left lung tumors – 100%) Specificity = 23 : (23 + 0) = 100 % Sensitivity = 77 : (77 + 9) = 89,5 % (for left lung tumors – 100%)

  8. Results • Multiple pN2 disease was found in 30 of 77 patients (39,0%) initially classified fN1-2 in 1 of 32 patients (3,1%) initially classified fN0

  9. Conclusion • The absence of metastases in the lymph nodes by frozen section investigation predicts a negative nodal status with accuracy of 91,7 %. • Probably mediastinalnodes dissection could be abbreviated for patients with frozen section lymph node negative left lung tumors.

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