The IASLC Lung Cancer Staging Project A Proposal for a New International Lymph Node Map in the Forthcoming Seventh Edition of the TNM Classification for Lung Cancer

Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York City, New York 10065, USA.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer (Impact Factor: 5.28). 05/2009; 4(5):568-77. DOI: 10.1097/JTO.0b013e3181a0d82e
Source: PubMed


The accurate assessment of lymph node involvement is an important part of the management of lung cancer. Lymph node "maps" have been used to describe the location of nodal metastases. However, discrepancies in nomenclature among maps used by Asian and Western countries hinder analyses of lung cancer treatment outcome. To achieve uniformity and to promote future analyses of a planned prospective international database, the International Association for the Study of Lung Cancer proposes a new lymph node map which reconciles differences among currently used maps, and provides precise anatomic definitions for all lymph node stations. A method of grouping lymph node stations together into "zones" is also proposed for the purposes of future survival analyses.

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Available from: Dorothy J Giroux
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    • "Patients who underwent radical lobectomy at Zhongshan Hospital , Fudan University from October 2013 to July 2014 were enrolled in this study. Clinical and pathological TNM staging and the lymph node station numbers were determined according to the TNM Classification for lung cancer (Union for International Cancer Control, 7th Edition) [3]. The grouping criteria for this study were as follows: (1) diagnosed with lung cancer, (2) single lesion, (3) the tumor size on CT was ≤3 cm, (4) the hilar and mediastinal lymph nodes were 1 cm or less in long axis diameter measured on CT, (5) the tumor was located away from the segmental bronchi, (6) there was no finding of metastasis. "
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    ABSTRACT: To investigate lymph node metastasis especially the intrapulmonary node in clinical IA peripheral lung cancer patients to evaluate the indications for lung segmentectomy in lymph node level. Patients (n=292) with clinical stage IA peripheral lung cancer received radical lobectomy at our department between October 2013 and July 2014 were enrolled in our study. Lymph nodes were obtained during routine surgical procedures while segmental lymph nodes were dissected from the resected lobe for pathological examination. New classification for pulmonary adenocarcinoma with each histologic component was also analyzed. The percentage of patients found to have no lymph node metastasis was 90.4% (264/292). Tumor size on computed tomography and tumor consistency were independent predictors for lymph node metastasis. Tumor with a dominant ground-glass opacity (GGO) component was a good predictor for lymph node metastasis (p<0.001). Metastasis was more common in larger tumors (p<0.001), but there was non-tumor bearing segment metastasis even in tumor less than 1cm. Patients with micropapillary or solid component were correlated with lymph node metastasis (p=0.001 and p=0.009, respectively). The rate of metastasis to the lymph nodes is very low in clinical stage IA peripheral lung cancer patients. Patients with a dominant GGO component on CT might be the suitable candidates for lung segmentectomy because of almost no lymph node metastasis. Careful selection should be made for the patients with tumor size ≤2cm who had metastasized nodes in non-tumor bearing segment when considering segmentectomy. If the resected tumor had micropapillary or solid component, the lobectomy might be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    • "There are several modifications compared with the previous Naruke and Mountain and Dresler maps [5] [6], but probably the most important modification from the clinical point of view is the shift of the anatomical mediastinal midline to the left paratracheal margin, the so-called mediastinal oncological midline [3]. This change is important to be understood by radiologists, bronchoscopists , nuclear medicine specialists and surgeons because they have to locate the nodes correctly. "
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    ABSTRACT: Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.
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    • "Carte proposée par l'American Joint Committee for Cancer (AICC) en 2009 avec sa répartition en zones [32] "
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    ABSTRACT: Lung cancer is characterized by its lymphophilia. Its metastatic spread mainly occurs by tumor cells lymphatic drainage into the blood circulation. Initially, the lymph node TNM classification was based on clinical and therapeutic considerations, particularly concerning N2 involvement. The goals were to avoid futile exploratory thoracotomies without lung resection, to provide more accurate data from mediastinoscopy, and to take into account the radiation therapy fields. Since 1997, the international lymph node classification was more used to analyse the disparities within N1 and N2 groups. However, this attempt did not succeed in clarifying the lymphatic metastazing process, and was not progressing any more. Anatomy not being considered, it did not permit to grasp the anatomical and physiological significances of N2 and N3 involvement. In effect, this classification is now confined in zones and is lacking the anatomical and physiological descriptions that characterise the lymphatic pathways draining the lungs and their tumoral pathology. The stations proposed in numbers in cartographies should have gained in accuracy and in prognostic value if they had been expressed in their anatomical counterparts.
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