ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer
ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer
复制标题
DOI：
10.1016/j.ejcts.2006.08.008
复制
发表时间：
2006-11-01
影响因子：
3.4
通讯作者：
Weder, Walter
中科院分区：
文献类型：
--
作者：
Lardinois, Didier;De Leyn, Paul;Weder, Walter
欧洲胸外科医师协会（ESTS）组织了一次研讨会，讨论非小细胞肺癌的淋巴结分期。本次研讨会的目的是制定非小细胞肺癌（NSCLC）患者术中淋巴结分期的定义和手术程序以及切除淋巴结的病理学评价指南。相关的同行评议的出版物的主题，参与者的经验，并在线贡献的ESTS成员的意见，被用来达成共识。所有病例均建议进行系统性淋巴结清扫，以确保完全切除。如果肺门和叶间淋巴结的冰冻切片检查结果为阴性，则对T1期周围型鳞状细胞肿瘤进行特定肺叶的系统性淋巴结清扫是可以接受的;这意味着从三个站点（其中总是包括隆突下）至少切除三个肺门和叶间淋巴结以及三个纵隔淋巴结。选择淋巴结活检和取样是合理的，以证明淋巴结受累时，切除是不可能的。病理评估包括单独切除的所有淋巴结和留在肺标本中的淋巴结。在大体异常部位进行切片。如果肉眼检查未发现任何异常部位，建议在纵平面上对结节进行2 mm切片。常规检查苏木精-伊红阴性淋巴结中的微转移或孤立的肿瘤细胞是可取的。建议进行随机对照试验，以评估这些疾病患者的辅助治疗。遵循这些指南将使术中淋巴结分期和病理学评价标准化，并改善病理分期，这将有助于确定最佳的辅助治疗。(c)2006 Elsevier B. V.保留所有权利。
The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. The objective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and the pathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on the subjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus. Systematic nodal dissection is recommended in all cases to ensure complete resection. Lobe-specific systematic nodal dissection is acceptable for peripheral squamous T1 tumors, if hilar and interlobar nodes are negative on frozen section studies; it implies removal of, at least, three hilar and interlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies and sampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resected separately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does not detect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolated tumor cells in hematoxytin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patients with these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging and pathotogic evaluation, and improve pathologic staging, which wilt help decide on the best adjuvant therapy. (c) 2006 Elsevier B.V. All rights reserved.