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Original Research: Lung CancerCross-Disciplinary Analysis of Lymph Node Classification in Lung Cancer on CT Scanning
Section snippets
Methods
From April 2013 through July 2013, all members of the Fleischner Society, Society of Thoracic Radiology, General Thoracic Surgical Club, and the American Association of Bronchology and Interventional Pulmonology were invited to participate in an anonymous online 20-question image-based and text-based survey on lymph node classification for lung cancer staging on CT images. The survey was distributed using SurveyGizmo, a commercial online survey tool (Widgix, LLC dba SurveyGizmo). Cookie-based
Results
Complete responses were submitted by 337 individuals, representing approximately 25% participation. Respondents self-reported themselves as thoracic radiologists (n = 158), thoracic surgeons (n = 102), and pulmonologists who perform endobronchial ultrasonography (n = 77). Most respondents (89% [300 of 337]) practiced in North America.
Principal Findings
Our study reveals that 4 years after its introduction, the IASLC lymph node map is used by approximately 50% of thoracic radiologists, approximately 50% of thoracic surgeons, and approximately 50% of pulmonologists who perform endobronchial ultrasonography.
For lung cancer specialists who use the IASLC lymph node map, a disparity exists between the IASLC definition sets, their interpretation, and their application on CT imaging, in particular for lymph nodes (1) near the thoracic inlet, (2)
Conclusions
The presence of inconsistencies in lymph node classification among lung cancer specialists indicates that a universally implemented regional thoracic lymph node map has not yet been realized. One reason may be that lymph node stations are traditionally defined using anatomic textual descriptions that require an additional layer of interpretation before use in the operating room, bronchoscopy suite, or radiology reading room. The inconsistencies, ambiguities, and unpredictability introduced by
Acknowledgments
Author contributions: A. H. E-S. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. A. H. E-S., C. T. L., N. A. O., A. C. M., T. W. R., and E. H. B. contributed substantially to the study design/implementation, data analysis and interpretation, and writing of the manuscript.
Financial/nonfinancial disclosures: None declared.
Other contributions: The authors
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2018, Radiologic Clinics of North AmericaCitation Excerpt :Thus, when applied to CT imaging, these anatomic definitions can create ambiguity and result in interobserver variability.18–23 Variability in N1 versus N2, N2 versus N3, and N versus M occur particularly with lymph nodes located about the hilum, carina, thoracic inlet, axilla, internal mammary vessels, and diaphragm.18–23 Recent efforts in improving the accuracy of CT in differentiation of malignant from benign lymph nodes have mainly focused on the use of dynamic contrast enhancement and perfusion parameters with diagnostic performance similar to those of FDG-PET/CT demonstrated by a recent study.24
Response
2017, Chest
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.