A recent publication by a group of investigators at Northwestern University led by Dr. Karl Bilimoria (not Kyle as has been reported) in the Journal of the National Cancer Institute last week has been getting some notice by the popular press and pathologists alike. The report deals with looking at how many nodes are detected from colectomy specimens, with a goal of 12 being the minimum to accurately stage a patient.
It is well-known and accepted that the more nodes found, the greater the likelihood for detecting metastases and the more negative nodes the better. There are thoughts on this beyond the score card look Dr. Bilimoria and colleagues conducted. This group has also looked at other node counts in other GI cancers.
Here is a recent news story with some quotes pulled out:
http://apnews.myway.com/article/20080909/D933EOG04.html
"To check enough nodes, surgeons must remove enough of the fat tissue by the colon where they hide, and pathologists must painstakingly dissect that tissue to find the tiny nodes."
"Surgeons frequently tell of getting a pathology report of four clean nodes and asking the pathologist to find more, "and lo and behold, one of those additional nodes turns out to be positive," Bilimoria said."
"But he expects more 12-node checks soon, saying the National Quality Forum recently listed the standard as a sign of quality care and that at least one insurance giant has begun requiring proof of 12-node checks before listing surgeons as preferred providers."
"Meanwhile, he advises patients to ask about the 12-node check in choosing a surgeon and to check their pathology report to be sure it was done."
I have not read the paper through but 12 lymph nodes is a conservative #; some of this depends of course on the length of segment of colon removed, how much serosal fat is taken and extent of dissection in the lab whether it is done on fresh or fixed tissue. What concerns me is payers requiring a certain # when it may not quite get there for surgeons to be "listed as preferred providers". What could be next – pathology reports with explanations of less than 12-node counts, multiple levels on grossly benign lymph nodes, increased steps on endoscopic biopsies, etc…
Laboratories and pathologists strive to collect as much data for accurate staging as possible as best practice and if cases yield only 10 or 11 or do make it to 13 why should insurance companies be able to dictate "preferred provider"?
