Number of Lymph Nodes needed to adequately stage a patient.

[univlad]

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Is there an online list of the number of lymph nodes needed to adequately stage a patient of different types of specimens? Colon, esophagus, etc?

 

[b&ierstiefel]

Is there an online list of the number of lymph nodes needed to adequately stage a patient of different types of specimens? Colon, esophagus, etc?

Check out the AJCC staging manual. Don't know if this stuff is online though...try a google search.

 

[Cabbage Head]

Is there an online list of the number of lymph nodes needed to adequately stage a patient of different types of specimens? Colon, esophagus, etc?

Incoming annoying answer:

All of them.

 

[DarksideAllstar]

Incoming annoying answer:

All of them.

I was gonna say whatever you can find after a solid attempt or attempts . Are we talking neoadjuvant therapy? If so, I start submitting pericolonic fat, oodles and oodles of fat.

 

[DarksideAllstar]

duplicate

 

[djmd]

I was gonna say whatever you can find after a solid attempt or attempts . Are we talking neoadjuvant therapy? If so, I start submitting pericolonic fat, oodles and oodles of fat. All I know is that if I had colon ca, I want you to find that one positive LN so I get my chemo.

Don't quote me on this but I think one could request over treatment... (just like I guess one could refuse treatment) but your HMO may not pay for it...

 

[yaah]

The only ones with specific numbers that I know of are Colon and Breast. The others don't really have published criteria (other than "all of them.") Colon has been subjected to studies involving # of lymph nodes harvested, etc. Upper GI tract is very variable. Neck dissections usually have lots. The axilla is where they like to see a certain number but it usually isn't hard to find that many easily.

 

[DarksideAllstar]

Don't quote me on this but I think one could request over treatment... (just like I guess one could refuse treatment) but your HMO may not pay for it...

based on what I have seen in hem/onc clinic for the past week, chemo tx is definitely handed out with a + node, then on a case by case basis, so in a sense you are right in that if you can talk your oncologist into writing it you can get it (assuming its not for some intramucosal lesion- what is that Tis?).

 

[LADoc00]

I think there was a paper recently toting dissectaid, the alcohol/vinegar combo fixative, that Im using that said the average partial colectomy for tumor should have a minimum of 7.

 

[EUA]

I heard some scuttlebutt about needing to find >12 nodes in a colon as a requirement for reimbursement? Truth or lies? I read it in a surgery journal recently, in which the author concluded the article with some smartarse remark about how if/when that happens, pathologists will "magically" be finding so many more nodes! Jack*ss, and maybe your specimens will arrive magically oriented appropriately one of these days too.

 

[LADoc00]

I heard some scuttlebutt about needing to find >12 nodes in a colon as a requirement for reimbursement? Truth or lies? I read it in a surgery journal recently, in which the author concluded the article with some smartarse remark about how if/when that happens, pathologists will "magically" be finding so many more nodes! Jack*ss, and maybe your specimens will arrive magically oriented appropriately one of these days too.

Lies.....lies told to residents to drive them to find more nodes!!

But a funny lie.

I was once told that in your first 3 years out of training you only get 70% of normal reimbursement too. Also, that they keep a provider database on you and if you order too many immunos for a given specimen type, they dock you. ALL B.S. But amusing a pathologist would lie with such a straight face to me....

 

[djmd]

Damn, AdenoCA confined to a polyp.
0/8 nodes.

And I am going back to the bucket.

If it hadn't been adeno, Im fine.
If there were a few more nodes I'm fine..

oh well.

 

[torero]

On gastrectomy specimens you ideally need 15+
AJCC 6th ed. regional lymph node staging for gastric carcinomas:
N1 = 1-6 positive nodes
N2 = 7-15
N3 = 15+

 

[LADoc00]

On gastrectomy specimens you ideally need 15+
AJCC 6th ed. regional lymph node staging for gastric carcinomas:
N1 = 1-6 positive nodes
N2 = 7-15
N3 = 15+

Jeebus, how many gastrectomies do you get in private prac bro??

I have yet to see one.

 

[torero]

Jeebus, how many gastrectomies do you get in private prac bro??

I have yet to see one.

I’m at a group practice associated with a big university, and I’m only doing dermpath and GI. The weeks I’m on GI I get maybe one or two gastrectomies a week, and I see on average around 40 endoscopic accessions (about 2 biopsies per accession) daily.

 

[EUA]

Lies.....lies told to residents to drive them to find more nodes!!

But a funny lie.

I was once told that in your first 3 years out of training you only get 70% of normal reimbursement too. Also, that they keep a provider database on you and if you order too many immunos for a given specimen type, they dock you. ALL B.S. But amusing a pathologist would lie with such a straight face to me....

Actually, it was a love note to our entire pathology department from one of the most busy colorectal surgeons, with the implication that we are a bunch of lazy bastards. I wish I kept the article so I could link to it.

 

[LADoc00]

I’m at a group practice associated with a big university, and I’m only doing dermpath and GI. The weeks I’m on GI I get maybe one or two gastrectomies a week, and I see on average around 40 endoscopic accessions (about 2 biopsies per accession) daily.

You in Tulsa OK by any random crazy coincidence??

 

[DarksideAllstar]

based on what I have seen in hem/onc clinic for the past week, chemo tx is definitely handed out with a + node, then on a case by case basis, so in a sense you are right in that if you can talk your oncologist into writing it you can get it (assuming its not for some intramucosal lesion- what is that Tis?).

Update (not that anyone cares), onc will give chemo if you have a T3N0Mx colon adenoca with +LVI, otherwise no chemo unless +nodes.

 

[torero]

You in Tulsa OK by any random crazy coincidence??

Nope, northeast.

 

[beary]

I think there was a paper recently toting dissectaid, the alcohol/vinegar combo fixative, that Im using that said the average partial colectomy for tumor should have a minimum of 7.

I just used dissectaid for the first time a few days ago. I thought it seemed to help, but didn't based on the extremely small number of lymph nodes I got out of my many cassettes of "probable lymph nodes."

What are folks experiences with this stuff?

 

[beary]

Damn, AdenoCA confined to a polyp.
0/8 nodes.

And I am going back to the bucket.

If it hadn't been adeno, Im fine.
If there were a few more nodes I'm fine..

oh well.

I am sorry. 🙁 I almost always have to go back to the bucket on colons. I HATE it.