UNASSIGNED: 7061 Background: Pathologic nodal stage predicts prognosis in @entity1 with surgically resected @entity2 . While accurate mediastinal @entity1600 ( @entity1600 ) examination depends on surgical and pathology practices, intrapulmonary @entity1600 (N1) evaluation rests solely on pathologic inspection. A median of 5 N1 LNs were examined in the ACOSOG @entity34262 trial and a median of 3 LNs were examined in the Memphis Metropolitan Area Quality of Surgical Resection cohort. We examined the frequency of unexamined N1 LNs (ULN1) in @entity2 specimens and how their examination impacts pathologic stage. METHODS: Prospective case-control study of remnant resected @entity2 specimens was performed by special pathology examination (SPE) after routine pathology evaluation (RPE). SPE included additional gross dissection and light microscopy of @entity1600 -like material. ULN1 retrieved by SPE were compared to those recovered by RPE in study and an external control cohort matched for pathologist and extent of resection. RESULTS: Additional ULN1 were retrieved in all @entity1 (Table; N=29). @entity3 was discovered in 19 of 223 (8.5%) ULN1 from 28% of @entity1 . Ten percent of @entity1 were pathologically upstaged; two previously pN0 @entity1 were found to have positive LNs and one @entity1 was found to have a previously undetected satellite nodule. @entity420 and @entity957 were found in 73% and 27% of ULN1, respectively. The median size of benign ULN1 was 0.6 cm (range 0.1-2.7 cm) and the median size of metastatic ULN1 was 1.2cm (range 0.1-2.4cm; p<0.0001). Median time for SPE was 30 minutes. CONCLUSIONS: RPE frequently leaves N1 LNs unexamined, a significant proportion of which harbor metastatic disease. Although LNs with @entity3 tend to be larger than those without, the significant overlap precludes use of size as a discriminating characteristic. SPE improves N1 @entity1600 examination which may impact prognosis and adjuvant management. Improvement in RPE is needed in @entity2 resection. [Table: see text].

Incomplete intrapulmonary @entity1600 retrieval with routine pathology evaluation of resected XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity34262 :: ('956691(Tax:155864)', 'Gene') :: ['Z0030'] @entity2 :: ('MESH:D008175', 'Disease') :: ['lung cancer'] @entity1600 :: ('MESH:D014388', 'Disease') :: ['LN', 'lymph node'] @entity957 :: ('MESH:D002294', 'Disease') :: ['squamous cell carcinoma'] @entity3 :: ('MESH:D009362', 'Disease') :: ['metastasis', 'Metastasis'] @entity420 :: ('MESH:D000230', 'Disease') :: ['Adenocarcinoma']
@entity2 :: (MESH:D008175,Disease) :: ['lung cancer']
