CHEST Guidelines-Misclassification-of-Lymph-Nodes-in-Lung-Cancer-St

Misclassification-of-Lymph-Nodes-in-Lung-Cancer-St

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The editorial by Galit Aviram and Marie-Pierre Revel highlights the ongoing challenges in lymph node classification for lung cancer staging, focusing on the International Association for the Study of Lung Cancer (IASLC) lymph node map. Lung cancer remains a leading cause of cancer-related deaths globally, making precise staging critical for prognosis, treatment selection, and clinical trial standardization. Accurate assessment of lymph node status within the tumor/node/metastasis (TNM) system is particularly challenging.<br /><br />Historically, lymph node maps have evolved, with the Naruke map originating in Japan, and subsequent developments leading to the MD-ATS map in the US. Discrepancies between these maps sometimes result in differing cancer staging. The IASLC map, included in the seventh edition of the TNM system since 2009, aims to standardize and unify nomenclature internationally.<br /><br />However, research presented by El-Sherief and colleagues reveals significant misclassification issues in real-world use of the IASLC lymph node map. An online survey of North American specialists in thoracic radiology, surgery, and pulmonology showed a lack of uniform adoption, with only half using the IASLC map; many still adhere to the older MD-ATS system. Even among those familiar with the IASLC map, correct classification rates for lymph nodes were low, and mistakes in staging were prevalent, often exceeding 50%. These misclassifications can impact treatment decisions and patient outcomes.<br /><br />The editorial calls for improved methods to reduce these errors, proposing more detailed clarifications in subsequent TNM updates and the development of interactive, computerized tools for accurate lymph node classification. A recent automated method for identifying and labeling mediastinal lymph nodes using CT data shows promise in addressing these challenges. The authors urge further efforts in simplifying and enhancing the usability of the IASLC map, emphasizing the need for standardized, globally applicable lymph node classification in lung cancer management.

Keywords

lymph node classification

lung cancer staging

IASLC lymph node map

TNM system

cancer-related deaths

misclassification issues

thoracic radiology

MD-ATS map

automated CT method

standardization