Standardized intrapulmonary lymph node dissection in lung cancer specimens: A national Colombian analysisCentral MessagePerspective
Habib Jussef Mantilla Gaviria, MD,
Stella Isabel Martinez Jaramillo, MD,
Carlos Andrés Carvajal Fierro, MD,
Ricardo Adolfo Zapata González, MD,
Camilo Montoya Medina, MD,
Luis Gerardo Garcia-Herreros Hellal, MD,
Luis Jaime Tellez Rodriguez, MD,
Juan Carlos Garzon Ramírez, MD,
Darwin Jose Padilla Padilla, MD,
Alberto Alejandro Correa Solano, MD,
Rodolfo Barrios del Rio, MD,
Mauricio Peláez Arango, MD,
Willfredy Castaño Ruiz, MD,
Andres Zerrate Misas, MD,
Lina Velásquez Gómez, MD,
Rafael José Beltrán Jiménez, MD,
Miguel Ricardo Buitrago Ramírez, MD,
José Andres Eduardo Jimenez Quijano, MD,
Fredy Orlando Mendivelso Duarte, MD,
Paula Antonia Ugalde Figueroa, MD
Affiliations
Habib Jussef Mantilla Gaviria, MD
Thoracic Surgery Department, Clínica Cancerológica de Boyacá, Tunja, Colombia
Stella Isabel Martinez Jaramillo, MD
Thoracic Surgery Department, Centro de tratamiento e investigación sobre Cáncer Luis Carlos Sarmiento Angulo, Bogotá, Colombia; Address for reprints: Stella Isabel Martinez Jaramillo, MD, Thoracic Surgery Department, Centro de tratamiento e investigación sobre Cáncer Luis Carlos Sarmiento Angulo, Cra. 14 #169-49, Bogotá, 110131, Colombia.
Carlos Andrés Carvajal Fierro, MD
Thoracic Surgery Department, Centro de tratamiento e investigación sobre Cáncer Luis Carlos Sarmiento Angulo, Bogotá, Colombia; Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá, Colombia
Ricardo Adolfo Zapata González, MD
Thoracic Surgery Department, Clínica Cardio VID, Medellín, Colombia
Camilo Montoya Medina, MD
Thoracic Surgery Department, Clínica Cardio VID, Medellín, Colombia
Luis Gerardo Garcia-Herreros Hellal, MD
Thoracic Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
Luis Jaime Tellez Rodriguez, MD
Thoracic Surgery Department, Clínica Cardioinfantil, Bogotá, Colombia
Juan Carlos Garzon Ramírez, MD
Thoracic Surgery Department, Clínica Cardioinfantil, Bogotá, Colombia
Darwin Jose Padilla Padilla, MD
Thoracic Surgery Department, Clínica General del Norte, Barranquilla, Colombia
Alberto Alejandro Correa Solano, MD
Thoracic Surgery Department, Clínica General del Norte, Barranquilla, Colombia
Rodolfo Barrios del Rio, MD
Thoracic Surgery Department, Clínica Universitaria Colombia, Bogotá, Colombia
Mauricio Peláez Arango, MD
Thoracic Surgery Department, Hospital Universitario San Ignacio, Bogotá, Colombia
Willfredy Castaño Ruiz, MD
Thoracic Surgery Department, Hospital Pablo Tobón Uribe, Medellín, Colombia
Andres Zerrate Misas, MD
Thoracic Surgery Department, Hospital Pablo Tobón Uribe, Medellín, Colombia
Lina Velásquez Gómez, MD
Thoracic Surgery Department, Hospital Pablo Tobón Uribe, Medellín, Colombia
Rafael José Beltrán Jiménez, MD
Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá, Colombia
Miguel Ricardo Buitrago Ramírez, MD
Thoracic Surgery Department, Instituto Nacional de Cancerología, Bogotá, Colombia
José Andres Eduardo Jimenez Quijano, MD
Thoracic Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
Fredy Orlando Mendivelso Duarte, MD
Epidemiology of the Surgery Department, Clínica Reina Sofia, Bogotá, Colombia
Paula Antonia Ugalde Figueroa, MD
Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
Objective: In patients with non–small cell lung cancer, lymph node assessment is essential for appropriate staging. The intrapulmonary lymph nodes (IPLNs) should be considered when assigning the N stage but are infrequently evaluated in Colombian centers, resulting in understaging that may hinder optimal treatment. Methods: We conducted a prospective study of IPLN dissection in patients with clinical stage I or II non–small cell lung cancer who underwent surgical resection at 9 institutions in Colombia between 2021 and 2023. IPLN dissection was performed by trained surgeons who collected lymph nodes from fresh specimens after resection and before formalin fixation. Results: One hundred patients were eligible for the analysis. Their mean age was 67 ± 10.9 years, and 76% were women. Most (74%) had adenocarcinoma, 20% had neuroendocrine tumors, and 6% had squamous cell carcinoma. Successful sampling and histopathologic analysis of at least one IPLN station was obtained in 85% of patients, 9% had upstaging due to positive N2 lymph nodes, and 5% had upstaging due to positive N1 lymph nodes. Among the patients with pN0 or pN1 disease, 3.2% (3 out of 91) were upstaged exclusively due to positive IPLNs. Conclusions: Fresh-specimen dissection to collect IPLNs is appropriate and feasible to achieve more accurate pathological staging in Colombian lung cancer patients. In clinical N0 patients, IPLN dissection maximizes selection for adjuvant therapy.
