| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ann Thorac Surg 2002;73:248-249
© 2002 The Society of Thoracic Surgeons
a Division of Thoracic Surgery, Saiseikai Central Hospital, 4-17, Mita 1-chome, Minato-ku, Tokyo 108-0073, Japan
e-mail: naruke{at}oak.ocn.ne.jp
Precise lymph node staging in lung cancer management is imperative for developing new treatment strategies.
Doctor Watanabe and colleagues point out the fact that designation of the sites of lymph nodes in Europe and the US, which are expressed by the stations in the lymph node map, could differ by doctors. Regarding lymph nodes in 41 cases of operations for lung cancer, two surgeons (the degree of their knowledge of mapping is unknown, one was trained in Japan and the other was trained in the United Kingdom) assess the difference between each other’s result by having a fixed station number. Presently, a number of variations of the lymph node map can be found, and this is causing confusion.
The Naruke map was established in 1967 by mapping in a histopathological study each intra and extrapulmonary lymph node (total, 1,925) from the thoracotomy findings and resected specimens in relation to the bronchial tree in 100 patients [1]. The findings were additionally examined and confirmed several times by mapping lymph nodes extracted from a total of 1,815 cases. The first English paper came out in 1976 [2] and 1978 [3]. Through the Japan-US joint study (Japan Representative Shichiro Ishikawa, MD, US Representative, Edward J. Beattie, MD) which started in 1970, the map gained mutual recognition as one that is designed for N staging, and in 1972, it was also used at Sloan Kettering Memorial as a worksheet for staging lung cancer. In 1976, it was officially approved at the American Joint Committee and began to be used by the UICC TNM Classification in 1980. Since then, there has been a total of three modified maps established: ATS Mapping (1981) and Mountain Mapping (1997) both from the US, and a German mapping according to the Deutsche Gesellshaft fur Thorax, Herz und Gefasschirurgie/Pneumologie (1988).
The ATS Mapping shows a mediastinoscopic identification in relation to major anatomical structures, however, the mediastinal pleura as mentioned in the Mountain Mapping does not appear in the ATS Map. The ATS Mapping describes pretracheal and paratracheal nodes as one. The German mapping and the Mountain Mapping do not mention pretracheal lymph nodes. There are controversies regarding nodal stations; the most crucial controversy over station is the boundary between N1 and N2 because of the absence of a universally common map of lymph node stations. Regarding the point which differentiates N1 and N2 by pleural reflection, given the prognostic difference, a pleural reflection does not seem an appropriate anatomical boundary between N1 and N2 stations in lung cancer [4].
In order to provide a better understanding and to facilitate an accurate description of lymph node station and ultimately to help solve the above controversial issue, the General Rule for Clinical and Pathological Record of Lung Cancer, which was published in 1987, clearly provides a lymph node map as well as anatomical findings and lymph node locations of operative and CT findings. Further, in 2000, the first English edition was published which includes the map as before, operative findings, CT findings and a graphic description and definition of the boundaries and group of various mediastinal lymph nodes [5].
It is expected that this book will reduce any confusion surrounding inter-observer variability in systematic nodal dissection, and that an universally common view may be found through the IASLC, the International Association for Study of Lung Cancer, Staging Committee Meeting.
References
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
