Mantilla Gaviria Habib Jussef, Martinez Jaramillo Stella Isabel, Carvajal Fierro Carlos Andrés, Zapata González Ricardo Adolfo, Montoya Medina Camilo, Garcia-Herreros Hellal Luis Gerardo, Tellez Rodriguez Luis Jaime, Garzon Ramírez Juan Carlos, Padilla Padilla Darwin Jose, Correa Solano Alberto Alejandro, Barrios Del Rio Rodolfo, Peláez Arango Mauricio, Castaño Ruiz Willfredy, Zerrate Misas Andres, Velásquez Gómez Lina, Beltrán Jiménez Rafael José, Buitrago Ramírez Miguel Ricardo, Jimenez Quijano José Andres Eduardo, Mendivelso Duarte Fredy Orlando, Ugalde Figueroa Paula Antonia
Thoracic Surgery Department, Clínica Cancerológica de Boyacá, Tunja, Colombia.
Thoracic Surgery Department, Centro de tratamiento e investigación sobre Cáncer Luis Carlos Sarmiento Angulo, Bogotá, Colombia.
JTCVS Open. 2024 Jun 18;20:174-182. doi: 10.1016/j.xjon.2024.06.004. eCollection 2024 Aug.
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.
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.
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.
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.
在非小细胞肺癌患者中，淋巴结评估对于准确分期至关重要。在确定N分期时应考虑肺内淋巴结（IPLN），但哥伦比亚的医疗中心很少对其进行评估，这可能导致分期不足，进而妨碍最佳治疗。
我们对2021年至2023年间在哥伦比亚9家机构接受手术切除的临床I期或II期非小细胞肺癌患者进行了IPLN清扫的前瞻性研究。IPLN清扫由经过培训的外科医生进行，他们在切除后、福尔马林固定前从新鲜标本中收集淋巴结。
100名患者符合分析条件。他们的平均年龄为67±10.9岁，76%为女性。大多数（74%）患有腺癌，20%患有神经内分泌肿瘤，6%患有鳞状细胞癌。85%的患者成功获取了至少一个IPLN站的样本并进行了组织病理学分析，9%的患者因N2淋巴结阳性而上调分期，5%的患者因N1淋巴结阳性而上调分期。在pN0或pN1疾病的患者中，3.2%（91例中有3例）仅因IPLN阳性而上调分期。
在哥伦比亚肺癌患者中，通过新鲜标本清扫收集IPLN对于实现更准确的病理分期是合适且可行的。在临床N0患者中，IPLN清扫可最大限度地选择辅助治疗。
